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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2015-7019
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: ONTARIO
6. Date incident was first observed.
29-JUL-13Product 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)PMRA Registration No. PMRA Submission No. EPA Registration No.
Product Name: glyphosate
- Active Ingredient(s)
- GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
10. Site pesticide was applied to (select all that apply).
Site: Other / Autre
Préciser le type: buffer strip
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
Neighbour has sprayed what caller believes to be glyphosate on the vegetative buffer strip that sits along the fence line on his property. Approximately 2 meters of this buffer strip was reportedly sprayed with a herbicide.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
Herbaceous Plants / Plante herbacée
2. Common name(s)
mixed vegetation
3. Scientific name(s)
Unknown
4. Number of organisms affected
Unknown
5. Description of site where incident was observed
Fresh water
Terrestrial
Roadside
Salt Water
6. Check all symptoms that apply
Visible injury ( eg. chlorosis, necrosis, bleaching)
7. Describe symptoms and outcome (died, recovered, etc.).
Caller keeps a vegetative buffer strip along his fence line to prevent erosion and to provide habitat along the corn field including milkweed for Monarch butterflies. Approximately 2 meters of this buffer strip was reportedly sprayed with a herbicide and is brown in colour on both sides of the fence. The damage was to weeds and not to cash crops.
8. a) Was the incident a result of (select all that apply)
Application
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?
No
9. b) Up to 3 days after application?
No
10. a) Was there a buffer zone?
No
10. b) What type?
Aquatic
10. c) What was the size of the buffer zone?
11. a) Were environmental samples collected and analysed?
No
