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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-4380

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: x

Prov / State: x

Country: x

Postal Code: X

3. Select the appropriate subform(s) for the incident.


4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA


6. Date incident was first observed.


Product Description

7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.


PMRA Registration No. 14879      PMRA Submission No.       EPA Registration No.


  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


10. Site pesticide was applied to (select all that apply).

Site: Agricultural-Outdoor/Agricole-extérieur

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Rate: Unknown Site: Canola fields surround the hives for 5km; were still blooming at time of application Pest: unknown Method: uncertain - spray planes seen & heard in the area, but not known specifically which fields were sprayed with which products Weather: calm, sunny, 20 degrees Anecdotally, Chlorpyrifos Lorsban (e.g. 14879) was being sprayed in the area at the time, but unknown specifically what product/chemistry was responsible.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Terr. Invrtbrt-Honey Bee/Inv.Ter-Abeille

2. Common name(s)


3. Scientific name(s)


4. Number of organisms affected


5. Description of site where incident was observed

Fresh water



Salt Water

6. Check all symptoms that apply


7. Describe symptoms and outcome (died, recovered, etc.).

adult foraging bees, 25 hives approx. half a million bees lost (estimate 40% losses, 50,000 bees per hive). Death; dead bees on ground outside affected hives. Noticed 9am Tues July 31st, worker bees were still dying/being cleared out of the hives. No unusual behaviour observed, just dead and dying. death of entire foraging population of affected hives; reduced viablility of the hive due to loss of adult foraging (nectar pollen collecting bees); reduced honey yield.Incident reported on Aug 1, 2012 10:30 am Established yard - The beekeeper had continuously had bees at this yard site for approximately 10 years, and the site had been a bee yard operated by a previous beekeeper prior to that. These bees colonies were not moved for pollination.Hives were in good condition prior to the loss incident: Had god honey volume Disease testing: Mites: 2% - treated with formic acid No American foul brood No history of nozema

8. a) Was the incident a result of (select all that apply)


8. b) i) How many times has the product been applied this year?


8. b) ii) What was the date of the last application?


9. Did it rain

9. a) During application?


9. b) Up to 3 days after application?


10. a) Was there a buffer zone?


10. b) What type?

10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?


To be determined by Registrant

12. Severity classification (if there is more than one possible classification, select the most severe)

13. Please provide supplemental information here