This form is blank example of an internal administrative form to be used by only CFIA inspectors, to specifically report on each authorized application of the fumigant methyl bromide which is a controlled substance under the Ozone Depleting Regulations under the Canadian Environmental Protection Act (CEPA). The basic information that inspectors are requested to fill in are:
The name of the things being treated (E.g. ship hold, container, commodity, packaging etc.), whether the things are imports or exports, where the things originated from originally and where they are going if being exported. It request information on the target pest(s) being fumigated as well as identification of the officially published requirements which call for the methyl bromide treatment. It also requests specific information about the actual treatment, such as which fumigation company and which actual fumigators did it along with their provincial pesticide license numbers. It also requests specific information about the amount of the chemical used, the dates of it application, the duration and temperature as well as the rate applied. It requests the identification of other CFIA forms crossed referenced to the treatment, such as the Notice of Requirement to Treat or Process (CFIA/ACIA 0112) or Ship Inspection - Not Approved for Loading (CFIA/ACIA 1281) both requiring actions, ie the treatment, to be taken by the owner of the things. There is also a space for inspectors to provide comments.