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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-4379

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: SASKATCHEWAN

6. Date incident was first observed.

21-JUL-12

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)

PMRA Registration No. 14879      PMRA Submission No.       EPA Registration No.

Product Name: LORSBAN 4E INSECTICIDE

  • Active Ingredient(s)
    • CHLORPYRIFOS

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: Wheat field

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

Rate: Unknown Site: Wheat field (and or possibly nearby canola field) Pest: Wheat Midge Method: Aerial

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)

Unknown

3. Scientific name(s)

Unknown

4. Number of organisms affected

500000

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.).

adult foraging bees, 24 hives approx. half million bees lost (estimate 40% losses, 50,000 bees per hive). death; dead bees on ground outside affected hives; noticed on July 23rd. death of majority of foraging population of affected hives; reduced viablility of the hive due to loss of adult foraging (nectar pollen collecting bees); reduced honey yield.Environmental samples collected by beekeeper; not analyzed by the PMRA as of date report submitted. Contact Saskatchewan Regional Pesticide Compliance Program for further information (File: #). Land Location: #-

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

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