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Health Concerns

Drug Offence and Disposition Report (HC/SC 3515)

Cat. No.: HC/SC 3515 (09-2007)

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  • Follow-up to previous request
  • Correction to a previously sent form
  • Please select the section under which authorization of destruction is required under the Controlled Drugs and Substances Act.
  • You MUST check ONE of the following boxes to identify the purpose of the report being sent to Drug Analysis Service.
    • s. 24(4) Pursuant to court order
    • s. 25 No application for return of controlled substance within 60 days
    • s. 26 Security, health or safety hazard
    • s. 27 Pursuant to court order
    • s. 28 Consent received
    • s. 29 Emergency Destruction of plants
  • 1 Name and address of organization responsible for the seizure
    • POLICE
    • CBSA
    • Telephone No.
    • Fax No.
  • 2 Date File Opened (yyyy-mm-dd)
  • 3a POLICE: File Reference No.
  • 3b CBSA: File Reference No.
  • 4. POLICE: Exhibit Report No.
  • DEFENDANT (Use a separate form for each defendant or "No Case Exhibit")
    • 5 Name
    • 6 Sex
    • 7 Place of birth
    • 8 Date of birth (yyyy-mm-dd)
    • 9 Address
    • 10 Province
    • 11 Occupation
    • 12 Citizenship
    • 13 FPS
    • 14 Subject is known to use (list all drugs)
  • OFFENCE AND DISPOSITION OF CHARGES
    • 15(a) Act and section
    • 16(a) Name of Drug
    • 17(a) Date of arrest (yyyy-mm-dd)
    • 18(a) Place of offence
    • 19(a) Date of trial (yyyy-mm-dd)
    • 20(a) Place of trial
    • 21(a) Act and section or C.C. (conviction)
    • 22(a) Date of sentence (yyyy-mm-dd)
    • 23(a) Disposition of charge
    • 24(a) Sentence
    • 15(b) Act and section
    • 16(b) Name of Drug
    • 17(b) Date of arrest (yyyy-mm-dd)
    • 18(b) Place of offence
    • 19(b) Date of trial (yyyy-mm-dd)
    • 20(b) Place of trial
    • 21(b) Act and section or C.C. (conviction)
    • 22(b) Date of sentence (yyyy-mm-dd)
    • 23(b) Disposition of charge
    • 24(b) Sentence
  • CONTROLLED SUBSTANCES TO BE DESTROYED
    • 25. Item No.
      • 1
      • 2
      • 3
      • 4
      • 5
      • 6
    • 26. Date seized (yyyy-mm-dd)
    • 27. Drug analyzed as
    • 28 Drug Suspected as
    • 29. Name of drug(s) and other item(s) seized
    • 30. Stage of production (for plants)
    • 31. Quantity
    • 32. Unit (eg. kg, ml, plants)
    • 33. Received by
    • 34 (a) Samples taken
      • (b) Photos taken
      • (c) Prosecutor notified
      • (d) Prosecutor's Name
      • Tel. No.
      • Fax No.
    • 35 Outline of case (Police use only)
      • SUB Status
      • Zone
      • Watch
      • Date reported (yyyy-mm-dd)
    • 36 Name and signature of first officer responsible
      • Date (yyyy-mm-dd)
      • Name and signature of second officer responsible
      • Date (yyyy-mm-dd)
      • Time reported
    • 37. On behalf of the Minister of Health, I hereby authorize, pursuant to section of the CDSA, the destruction of the controlled substances listed above, by incinerator or other appropriate means and in compliance with municipal, provincial and federal environmental regulations.
      • Signature
      • Date (yyyy-mm-dd)
  • POLICE SERVICE
    • 38 Once local destruction has been effected, complete this section and email to drug_disposal@hc-sc.gc.ca or forward copy to:
      Seized Controlled Substances Disposal Unit
      National Compliance and Exemption Division
      Office of Controlled Substances
      Health Canada
      150 Tunney's Pasture Driveway
      A.L. 0300B
      Ottawa ON K1A 0K9
      Telephone No.: (613) 946-1143
      Fax No.: (613) 941-4760
    • 39. Name and address of Police Force responsible for destruction, if different from box 1 above.
    • 40 Destruction date (yyyy-mm-dd)
    • 41 Witness 1
    • 42 Witness 2
    • 43 Facility location
    • 44 Method of Destruction

Instructions for completing the form

ONE of the 6 boxes at the top of the form MUST be checked to identify the type of report being sent to Drug Analysis Service (DAS).

  • For Section 24(4) - Send partially completed form. Submit follow-up when information in boxes 15 to 24 is available. ATTACH A COPY OF THE COURT ORDER.
  • For Section 25 - Send in duplicate if form fully completed. If information in boxes 15-24 (Offence and disposition of charges) is not available, send partially completed copy 2 and follow-up when this information becomes available.
  • For Section 26 - Provide reason(s) why immediate destruction is requested. Refer to section 26 of the Act.
  • For Section 27 - Send fully completed form to OCS. ATTACH A COPY OF THE COURT ORDER.
  • For Section 28 - Enter available information and send in duplicate.
    ATTACH EVIDENCE OF THE LAWFUL OWNER'S CONSENT.
  • For Section 29 - Complete box 34(a) or (b), as applicable, and indicate the prosecutor's concurrence by filling boxes 34(c) and 34(d). Fax completed form to (613) 941-4760, then YOU MUST follow-up BY MAIL when information in boxes 15 to 24 is available.
  • 1 Name and address of organization responsible for the seizure
  • 2 Date file opened
  • 3a Police File Reference No.
  • 3b CBSA File Reference No.
  • 4 Police Exhibit Report No.

Defendant

  • 5 Name of the defendant (separate form for each defendant or "NO CASE EXHIBIT")
  • 6 Sex of the accused
  • 7 Place of birth of the accused
  • 8 Date of birth of the accused
  • 9 Address of the accused
  • 10 Province where the accused resides
  • 11 Occupation of the accused
  • 12 Citizenship of the accused
  • 13 FPS number (if known)
  • 14 List specific drugs accused is known or suspected to use. Based on self admission and any other available information

Offence and Disposition of Charges

If more than 2 charges are laid, attach an additional HC/SC 3515 with details of additional charge(s)

  • 15 Statute and Section under which charge was laid.
  • 16 Name of drug for which charge was laid.
  • 17 Date of arrest
  • 18 Place of offence
  • 19 Date of trial
  • 20 Place of trial
  • 21 Statute and Section of Disposition
  • 22 Date of sentence
  • 23 Disposition of charge (Guilty, acquitted, withdrawn etc.)
  • 24 Describe sentence imposed by court (ie. jail, fine, absolute discharge, etc.). If jail term taken in lieu of fine, state.

Controlled Substances to Be Destroyed

If additional space is required, list on form HC/SC 3525

  • 25 Sequential numbering of exhibits as they appear in 29.
  • 26 Date exhibit(s) seized
  • 27 Check if the drug has been analysed
  • 28 Check if the description provided is what the drug is suspected to be
  • 29 Brief, exact description of drug exhibit(s)
  • 30 Indicate the stage of production of the plants to be destroyed: cultivation, propagation or harvesting
  • 31 Weight, quantity or exact amount of each exhibit seized.
  • 32 Specify units, e.g. plants, tabs, grams etc. Please do not state baggie, vial, etc.
  • 33 Initials of person holding exhibit(s), i.e., exhibit person or seizing officer
  • 34 See instructions at the top regarding Section 29
  • 35 Briefly outline the details of the case (i.e. origin of the seized asset, statements by the accused, etc.). Use page 4 if further space is required. (Police use only)
  • 36 Signature of officer(s) responsible
  • 37 For Ministerial use only

Police Service

  • 38 Address of DAS

The following MUST be completed after the exhibit(s) listed in 29 have been destroyed locally upon authorization obtained from DAS:

  • 39 Name, address, tel. no. and fax no. of police force responsible for destruction
  • 40 Destruction Date
  • 41 Name and signature of witness 1
  • 42 Name and signature of witness 2
  • 43 Facility Location
  • 44 Method of Destruction