Health Canada
www.hc-sc.gc.ca
Common menu bar links
Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2016-0916
2. Registrant Information.
Registrant Reference Number: 2016-29
Registrant Name (Full Legal Name no abbreviations): MONSANTO CANADA INC.
Address: 180 KENT STREET, SUITE 810
City: OTTAWA
Prov / State: ONTARIO
Country: CANADA
Postal Code: K1A 0B6
3. Select the appropriate subform(s) for the incident.
Environment
4. Date registrant was first informed of the incident.
18-JAN-165. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
Unknown
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. Unknown
Product Name: Roundup
- Active Ingredient(s)
- GLYPHOSATE
7. b) Type of formulation.
Application Information
8. Product was applied?
Unknown
9. Application Rate.
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).
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
Trees or shrubs / Arbre ou arbuste
2. Common name(s)
Rasberry bush
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 plant stance
7. Describe symptoms and outcome (died, recovered, etc.).
Customer had made an application of Roundup to RR corn, an adjacent neighbor claimed that Roundup had drifted from the corn into his rasberry crop and caused crop damage. This was approximately 40 feet from the nearest application point. Customer indicated samples of the rasberry plants were positive for glyphosate residue. Not clear who had conducted this test or the actual results. No other information was provided.
8. a) Was the incident a result of (select all that apply)
Drift
N/A
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?
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
