Complaint and Violation Report

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Instructions

Mandatory Pesticide Incident Reporting (Registrants and Applicants)

In accordance with the Pest Control Products Incident Reporting Regulations, pesticide registrants and applicants are required to report to the Pest Management Regulatory Agency (PMRA) all incidents associated with their products.

If you are submitting a Mandatory Pesticide Incident Report, please use Mandatory Pesticide Incident Reporting form for Registrants and Applicants.

Report a Pesticide Incident (Public)

A pesticide incident is a negative effect (adverse reaction) to humans, animals (pets or livestock) or the environment (plants or wildlife) that can result from being exposed to a pesticide. Pesticide incidents include:

Effects to humans, such as skin rash, headache or nausea
Effects to a domestic animal like a pet or farm animal, such as vomiting, bleeding or itchy skin
Effects to the environment, such as dead fish or birds or yellowed leaves
Problems with pesticide containers, such as a leaking container, misfiring spray can or blocked nozzle.

For more information on submitting an incident report, please visit Health Canada’s webpage: Report a Pesticide Incident.

For complaints or suspected violations of the Pest Control Products Act (PCPA), please use the Form below.

Instruction 1

Submitter

The person identified on this form will be the one with whom further communication will be made, if required. Submitter could be an individual or a company representative submitting information on a complaint or suspected violation associated with the pesticide products. Provide the requested information, such as, your name, telephone number, email address etc. Failure to provide accurate personal information may limit the PMRA’s ability to effectively follow-up on the complaint.

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Instruction 2

Suspected violator

Identify the individual by first name and last name or provide the name of the company. Provide as much details as possible.

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Instruction 3

Products

Identify the product name, registration number, lot/batch number or active ingredients, if any. Click the button “Add more products” to add more than one product that may have been potentially involved in the complaint or suspected violation.

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Instruction 4

Complaint or Suspected Violation

Identify if the complaint or suspected violation is related to an unregistered product or due to misuse of a pesticide product and the date the issue occurred. Provide information on the type of issues, its impact on health / environment, if the issue is still occurring and if you have notified any other government regulatory authorities of the issue.

Describe the issue in details. For example,

What is the violation? When and where did the violation took place? How did this violation happen? What is the impact of this violation?
Any other relevant information which would assist the PMRA in verifying potential non-compliance.

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Instruction 5

Attachments

Attach any files you wish to include with the online form.

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Instruction 6

Authorization

Authorize Health Canada's use of your contact information and contents of the submitted report.

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1. Submitter^{Instruction 1}

The personal information provided under this section is kept confidential in accordance with the Privacy Act. The personal information is needed to determine if there is any further follow-up required with the submitter for more information.

Are you reporting as (required)

Company name (required)

Title / Position

First name (required)

Last name (required)

Address

City

Country

Other country (required)

Province

State

Region

Postal code / Zip

Telephone (including area code)

Telephone (including country code)

Email address (required)

Confirm your email address (required)

2. Suspected violator^{Instruction 2}

Type of violator (required)

Other type of violator (required)

Company name (required)

First name (required)

Last name (required)

Address

City (required)

Country (required)

Other country (required)

Province (required)

State (required)

Region (required)

Postal code / Zip

Telephone (including area code)

Telephone (including country code)

3. Products^{Instruction 3}

You can have up to 3 pesticide products. Click on the "Add more products" button to add additional products. Click on the "Remove Product" button to remove a product.

Product # {{$index + 1}}

Product name

Registration number (digits only)

Is the product registered in Canada? (required)

Lot / Batch number

Active ingredients (maximum of 500 characters)
{{500-product.activeIngredients.length}}

4. Complaint or suspected violation^{Instruction 4}

Violation related to (required)

Violation date (YYYY-MM-DD) (required)

Type of violation (required)

Other type of violation (required)

Impact of suspected violation

Other impact of suspected violation (required)

Is the suspected violation still occurring? (required)

Other Regulatory Agencies that have been notified

Describe the violation in detail (maximum of 2,000 characters) (required)
{{2000-violation.violationInDetail.length}}

5. Attachments^{Instruction 5}

Note: There is a known issue with Internet Explorer that may impact your ability to upload attachments. If you experience any difficulties in uploading attachments, please try one of the following:

Use another browser,
Close and restart Internet Explorer, or
Restart your computer.

Add any additional attachments you wish to include in the online form.

6. Authorization^{Instruction 6}

I authorize Health Canada to provide my contact information to the manufacturer / importer / distributor or user, in order to facilitate verification of compliance, if necessary (required)

Yes

I authorize Health Canada to release the contents of this report and refer my complaint / incident and product details to another organization outside Health Canada to facilitate verification of compliance, if necessary (required)

Yes

I have read, understood and agree with the Privacy notice statement (required)Privacy notice statement

I have read, understood and agree with the Security notice (required)Security notice

Complaint and Violation Report

Privacy notice statement

Security notice: Up to Protected B only

Instructions

Mandatory Pesticide Incident Reporting (Registrants and Applicants)

Report a Pesticide Incident (Public)

1. SubmitterInstruction 1

2. Suspected violatorInstruction 2

3. ProductsInstruction 3