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Pest Management Regulatory Agency
2720 Riverside Drive
Attention: Pesticide Incident Reporting Program
Phone: 1-800-267-6315 within Canada
1-613-736-3799 outside of Canada (Long distance charges apply)
Pesticides are tested and evaluated for environmental and health risks before they are registered by the PMRA. However, some adverse effects may not become evident until the product is used under "real-life" circumstances. The information you are about to report will provide the PMRA with valuable data regarding potential risks to humans from the use of pesticides in "real-life" circumstances.
Information provided by the public and by professionals is added to the PMRA database on pesticides. The database will be regularly searched for any type of pattern related to a specific pesticide. If the result of a search indicates that there is a trend, such as multiple incidents for a particular pesticide, the PMRA will evaluate the information in conjunction with scientific literature. If evaluation of this information identifies a safety issue, appropriate action will be taken. Such action could range from minor label changes to discontinuation of the product.
In order for the information you provide to be useful, it is necessary to be as specific as possible, particularly with regards to the type of pesticide and the effect(s) experienced.
Complete a separate form for each person affected
1. Provide location where the incident occurred (see Confidentiality Statement).
2. Who is reporting this incident?
3. Date incident occurred (dd/mm/yyyy):
4. If known, provide the product registration number and product name of the pesticide, both of which are on the product label. If not known, list the active ingredients.
Registration number examples:
Product name example:
Active ingredient example:
5. If known, describe the application of the pesticide. Include the amount of pesticide applied (application rate), the site that the pesticide was applied to and the method of application.
Application rate examples:
Method of application examples:
6. Age: (see Confidentiality Statement)
7. Describe all symptoms. Include the length of time the symptom(s) lasted, the severity of the symptom(s), and how often the symptom(s) occurred. Also describe any medical treatment received, including medication prescribed, test results and length of hospitalization (if applicable).
8. How was the person exposed to the pesticide? Include, if available, the amount of the pesticide the person was exposed to, and how long or how often the person was exposed to it.
9. What was exposed?
10. Has this incident been reported to the manufacturer?
If so, when was it reported (dd/mm/yyyy)?
What was the name of the manufacturer?
The name, address and telephone number of the manufacturer is listed on the label.
11. Additional information can be provided in the space below, or on a separate sheet.
Important: do not include personal information such as names or addresses. (see Confidentiality Statement)