Report of Non Compliant Agricultural Or Veterinary Chemicals Or Advertising

Report of Potential Non-Compliant Supply or Advertising of Agricultural or Veterinary Chemicals

Please use this form to report unregistered or non-compliant agricultural or veterinary chemical products or advertising, providing as much relevant information as possible. Information received by the APVMA is treated as confidential.

Product name(as listed on the container)
E.g. ‘Brand X Fast Acting Fly Spray’

Active constituents(if known – may be on label)

E.g. ‘Bifenthrin and Citronella Oil’
Manufacturer name(if known)
Manufacturer address(if known)
Supplier name(if known)
Supplieraddress(if known)
Location where the product was found/identified and/or website/publication in which advertisement appeared(Please indicate issue if a publication)
E.g. ‘Store X at street/suburb’ ‘Magazine X on month/year’ ‘
Statements(What statements are made regarding this product?)
E.g. ‘Kills all flying insects’ ‘Environmentally friendly’ ‘Non-toxic’
What are your concerns regarding this product?
E.g. ‘Contact details on the label are incorrect’ ‘Does not show APVMA approval number on the label’
(See further information on page 2 regarding adverse reactions or product not working as expected)
Your name
Company / organisation
Address
Telephone / Facsimile
Email address
Signature /

Date

Additional Information (any other information or comments you wish to make – this may assist in our evaluation)

DO NOT SEND PRODUCTS, CONTAINERS OR CHEMICALS TO THE APVMA

Please attach any labels, advertising material, photographs or photocopies relating to the product/s of concern but do not send product containers, chemicals or product samples to the APVMA as these may present a health and safety risk.

If your concerns relate to a lack of efficacy or an adverse reaction to a product please contact the Adverse Experience Reporting Program. Details are available at

Providing your contact details allows us to seek further information or clarification if necessary. These details also allow feedback at the completion of APVMA enquiries. Failure to provide contact details may result in the report receiving low priority.

All reports are treated with the strictest confidence, however the release of details may be required to comply with legislated obligations.

When you have assembled as much relevant information as possible, please enclose it together with this form and return to:

The Compliance Section

Compliance and Regulatory Support Program

Australian Pesticides and Veterinary Medicines Authority

PO Box 6182, Kingston ACT 2604.

Facsimile: (02) 6210 4813

Preferred option – E-mail:

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