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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2015-2254
2. Registrant Information.
Registrant Reference Number: x
Registrant Name (Full Legal Name no abbreviations): x
Address: x
City: x
Country: 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-MAY-14Product 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: x
- Active Ingredient(s)
- CLOTHIANIDIN
- THIAMETHOXAM
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).
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
Information on crops located near the beeyards: 120ac of Corn was 10m and NE of the beeyard, and was planted on 2014-05-28 (evening).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)
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
Death
7. Describe symptoms and outcome (died, recovered, etc.).
There were a total of 14 colonies in the bee yard. There were 14 affected colonies. No treatments in the past year. Bees were Actively foraging when incident occurred; actively foraging when questionnaire being filled out. There were 0-500 dead bees observed outside of each hive. Adult bee symptoms included shaking/trembling/twitching and disoriented. No brood or queen symptoms observed. The weather at the time of the incident was sunny, light wind (NE), temperature was 20 C and humidity was moderate. The Last rain event occurred on 2014-05-27. Sample of dead bees had positive detects for thiamethoxam and clothianidin. Sample of comb pollen taken had positive detects for Thiamethoxam, clothianidin and imidacloprid.
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?
10. c) What was the size of the buffer zone?
11. a) Were environmental samples collected and analysed?
Yes
