Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2015-2232
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.
23-AUG-14
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.
PMRA Submission No.
EPA Registration No.
Product Name: Admire
PMRA Registration No.
PMRA Submission No.
EPA Registration No.
Product Name: Dithane
PMRA Registration No.
PMRA Submission No.
EPA Registration No.
Product Name: Cabri
PMRA Registration No.
PMRA Submission No.
EPA Registration No.
Product Name: Echo
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).
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: Watermelon is in the surronding area. watermelon grower is [name] - only one insecticide used: - Admire in drip irrigation @ 100ml/ac in the second week of June -Admire is for control of cucumber beetles - Other pesticides used: -Dithane(June applied) - rotated Cabvio and Echo - done by mid June
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.).
There were a total of 20 colonies in the bee yard. There were 20 affected colonies. Bees were actively foraging when questionnaire being fill out and there are a lack of foragers returning to hive. There were 0-500 dead bees observed outside of each hive. Brood symptoms included overall decline in brood production. Additionally, hives should be stronger. No queens observed at this site. Queens were lost at the "watermelon grading station yard" which is close to this yard. The weather at the time of the incident was wetter and cooler than normal summer.
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?
No
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