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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-4381

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).

Ground application reports mid-day spraying, 2pm through to sunset and spray activities 6am onwards.

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

Abnormal behavioural effects


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

Bookeeper indicates he has experienced three separate incidents of pesticide-related bee losses this year, this being the third. Dealth of adult foraging bees. No information at this time regarding scope of incident (s) in terms of number of bee yards colonies or of total bees lost etc: however, likely affected majority or all of adult foragaing bees at the affected bee yard(s).Average bee yard in SK is 24-48 colonies. At 50000 bees per colony and at 40% losses, a reasonable estimate might be 0.5 - 1.0 million bees lost per affected bee yard. Beekeeper operates 13 beeyards, with a total of 400 colonies. Beekeeper had visited the affected yards the night before and they were fine; the next evening the hives were surrounded with piles of dead bees, some still twitching. 27 hives, all hives affected - lost greater than 20% of the hive populations - has been a beeyard for 14 years, no movement for pollination - foraging on canola and wildflowers (weeds) in ditches - around sloughs. Hives were healthy prior, no nozema, afb. Fall mite counts were low. beekeeper does spring treatments with Apivar for mite control. Topography: less than a mile to the west there was blooming canola, in between was canola that had finished blooming. The spraying was throughout the half-section of canola that had mostly completed blooming. The spraying was witnessed by others that recounted it to the beekeeper later. Spraying started - water sources - would be sloughs within 400ft of the yards. Weather on day of application was beautiful and sunny.

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