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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2018-5366
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: ALBERTA
6. Date incident was first observed.
08-JUN-18Product 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: STRYCHNINE
- Active Ingredient(s)
- STRYCHNINE
7. b) Type of formulation.
Bait
Application Information
8. Product was applied?
Yes
9. Application Rate.
10. Site pesticide was applied to (select all that apply).
Site: Forest - Woods / Forêt et boisés
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
3 bait sites set out by the Government of Alberta for wolf reduction under the caribou plan were checked. Numerous deceased animals were found on June 8, June 27, July 24, July 28, and July 29 in 2018. A complaint was made under the Report A Poacher program and is being actively investigated by two Fish and Wildlife officers in Alberta. Investigation related to possible improper use/removal of strychnine.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
Mammal-Large,solitary/Mammifère-Grande
2. Common name(s)
Black wolf
3. Scientific name(s)
Canis lupus
4. Number of organisms affected
1
5. Description of site where incident was observed
Fresh water
Terrestrial
Forest
Salt Water
6. Check all symptoms that apply
Death
7. Describe symptoms and outcome (died, recovered, etc.).
The first bait site was explored on June 8, 2018 where a dead wolf was found in a remote meadow with a poison sign close by.
8. a) Was the incident a result of (select all that apply)
Application
Other
bait site
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?
10. c) What was the size of the buffer zone?
11. a) Were environmental samples collected and analysed?
No
To be determined by Registrant
12. Severity classification (if there is more than one possible classification, select the most severe)
Minor
13. Please provide supplemental information here
Subform IV: Environment (includes plants insects and wildlife)
1. Type of organism affected
Mammal-Large,solitary/Mammifère-Grande
2. Common name(s)
Coyote
3. Scientific name(s)
Canis latrans
4. Number of organisms affected
2
5. Description of site where incident was observed
Fresh water
Terrestrial
Forest
Salt Water
6. Check all symptoms that apply
Death
7. Describe symptoms and outcome (died, recovered, etc.).
The first bait site (remote meadow) was accessed again on June 27, 2018 to check in the adjacent timber and a coyote was found deceased. On July 28, 2018 at a different bait site in a remote part of the Little Smoky River, another deceased coyote was found.
8. a) Was the incident a result of (select all that apply)
Application
Other
bait site
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?
10. c) What was the size of the buffer zone?
11. a) Were environmental samples collected and analysed?
No
To be determined by Registrant
12. Severity classification (if there is more than one possible classification, select the most severe)
Minor
13. Please provide supplemental information here
Subform IV: Environment (includes plants insects and wildlife)
1. Type of organism affected
Mammal-Large,solitary/Mammifère-Grande
2. Common name(s)
Lynx
3. Scientific name(s)
Lynx
4. Number of organisms affected
1
5. Description of site where incident was observed
Fresh water
Terrestrial
Forest
Salt Water
6. Check all symptoms that apply
Death
7. Describe symptoms and outcome (died, recovered, etc.).
On July 28, 2018 at a bait site in a remote part of the Little Smoky River, a lynx was found deceased.
8. a) Was the incident a result of (select all that apply)
Application
Other
bait site
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?
10. c) What was the size of the buffer zone?
11. a) Were environmental samples collected and analysed?
No
To be determined by Registrant
12. Severity classification (if there is more than one possible classification, select the most severe)
Minor
13. Please provide supplemental information here
Subform IV: Environment (includes plants insects and wildlife)
1. Type of organism affected
Mammal-Large,solitary/Mammifère-Grande
2. Common name(s)
Fox
3. Scientific name(s)
Vulpes
4. Number of organisms affected
5
5. Description of site where incident was observed
Fresh water
Terrestrial
Forest
Salt Water
6. Check all symptoms that apply
Death
7. Describe symptoms and outcome (died, recovered, etc.).
The first bait site was explored on June 8, 2018 where the remains of two foxes were found in an open meadow. This site was accessed again on June 27, 2018 to check in the adjacent timber. Another deceased fox was found. On July 24, 2018 a different site was accessed (area was flooded) and part of a deceased fox was discovered. On July 29, 2018 a consumed fresh fox was found at the original site (which was not present in the month prior) .
8. a) Was the incident a result of (select all that apply)
Application
Other
bait site
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?
10. c) What was the size of the buffer zone?
11. a) Were environmental samples collected and analysed?
No
To be determined by Registrant
12. Severity classification (if there is more than one possible classification, select the most severe)
Minor
13. Please provide supplemental information here
Subform IV: Environment (includes plants insects and wildlife)
1. Type of organism affected
Mammal-Large,solitary/Mammifère-Grande
2. Common name(s)
Grizzly Bear
3. Scientific name(s)
Ursus arctos
4. Number of organisms affected
1
5. Description of site where incident was observed
Fresh water
Terrestrial
Forest
Salt Water
6. Check all symptoms that apply
Death
7. Describe symptoms and outcome (died, recovered, etc.).
On July 28, 2018 at a bait site in a remote part of the Little Smoky River, evidence of a deceased grizzly bear was found.
8. a) Was the incident a result of (select all that apply)
Application
Other
bait site
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?
10. c) What was the size of the buffer zone?
11. a) Were environmental samples collected and analysed?
No
To be determined by Registrant
12. Severity classification (if there is more than one possible classification, select the most severe)
Minor
13. Please provide supplemental information here
Subform IV: Environment (includes plants insects and wildlife)
1. Type of organism affected
Bird - Predatory / Oiseau - De proie
2. Common name(s)
Great Grey Owl
3. Scientific name(s)
Strix nebulosa
4. Number of organisms affected
1
5. Description of site where incident was observed
Fresh water
Terrestrial
Forest
Salt Water
6. Check all symptoms that apply
Death
7. Describe symptoms and outcome (died, recovered, etc.).
On July 28, 2018 at a bait site in a remote part of the Little Smoky River, evidence of a deceased great grey owl was found.
8. a) Was the incident a result of (select all that apply)
Application
Other
bait site
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?
10. c) What was the size of the buffer zone?
11. a) Were environmental samples collected and analysed?
No
To be determined by Registrant
12. Severity classification (if there is more than one possible classification, select the most severe)
Minor
13. Please provide supplemental information here
Subform IV: Environment (includes plants insects and wildlife)
1. Type of organism affected
Bird - Songbird / Oiseau - Chanteur
2. Common name(s)
Raven
3. Scientific name(s)
Corvus
4. Number of organisms affected
Unknown
5. Description of site where incident was observed
Fresh water
Terrestrial
Forest
Salt Water
6. Check all symptoms that apply
Death
7. Describe symptoms and outcome (died, recovered, etc.).
The first bait site was explored on June 8, 2018 where the remains of 4 ravens were found in an open meadow. This site was accessed again on June 27, 2018 to check in the adjacent timber. Another raven was found. On July 24, 2018 a different site was accessed (area was flooded) and a raven was discovered. On July 28, 2018 at a bait site in a remote part of the Little Smoky River, numerous ravens were found. On July 29, 2018 at the original bait site, a couple of ravens (which were not present in the month prior) were found deceased.
8. a) Was the incident a result of (select all that apply)
Application
Other
bait site
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?
Unknown
9. b) Up to 3 days after application?
Unknown
10. a) Was there a buffer zone?
Unknown
10. b) What type?
10. c) What was the size of the buffer zone?
11. a) Were environmental samples collected and analysed?
No
To be determined by Registrant
12. Severity classification (if there is more than one possible classification, select the most severe)
Minor
