Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-3737

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.

Environment

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

17-JUL-13

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.

Active(s)

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

Product Name: unknown

• Active Ingredient(s)
  • DIAZINON
  • METHOXYFENOZIDE
  • MEVINPHOS
  • TEBUFENOZIDE

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7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

9. Application Rate.

Unknown

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

Site: Unknown / Inconnu

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

To be determined by Registrant

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

Unknown

Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

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

2. Common name(s)

honey bee

3. Scientific name(s)

Unknown

4. Number of organisms affected

Unknown

5. Description of site where incident was observed

Fresh water

Terrestrial

Agricultural

Salt Water

6. Check all symptoms that apply

Abnormal behavioural effects

Death

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

Au total, le rucher comptait 375 colonie(s). Il y avait 112 colonie(s) touchée(s) et 0 colonie(s) morte(s).On a observé 501-1000 abeilles mortes a l'extérieur de la ruche. Dans le cas des abeilles adultes, les symptômes comprenaient agitation/tremblements/contractions. Aucun symptomes de couvain ou reines. L'échantillon de'abeilles mortes prélevé dans les ruches affectees a permis de détecter la présence de diazinon-o, diazinon, methoxyfenozide, mevinphos et tebufenozide. Au moment de l'incident, les conditions météorologiques étaient ensoleille, pas de vent, très chaud, très humide. Avant l'incident, il y avait en moyenne 16 cadres d'abeilles, 10 cadres de couvain et 5 cadres de pollen et de miel. Les organismes nuisibles suivants étaient présents dans le rucher touché l'an dernier;Varroa. Après l'incident, il y avait en moyenne 14 cadres d'abeilles, 10 cadres de couvain et 5 cadres de pollen et de miel. Après l'incident, les maladies ou les infestions d'organismes nuisibles indiqués précédemment ne sont pas aggravées. Des sources supplémentaires d'aliments ont été fournies aux abeilles, y compris sirop de sucre, supplement de pollen, patties En 2012, on a effectué les traitements suivants aux ruches : Amitraze et antibiotiques.En 2013, on a effectué les traitements suivants aux ruches : acide formiques. Renseignements sur les cultures situées près des ruchers : Cannebergière situé à 50m du rucher.On a appliqué du diazinon sur la culture.

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

Unknown

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

Unknown

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

Unknown

9. Did it rain

9. a) During application?

Unknown

9. b) Up to 3 days after application?

Unknown

10. a) Was there a buffer zone?

Unknown

10. b) What type?

Aquatic

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

11. a) Were environmental samples collected and analysed?

Unknown

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