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Pesticide Incident or Illness Complaint

  1. If you have been exposed to a pesticide, please call 911.

  2. Please include date and time when incident occurred.

  3. Physical address or nearest cross streets. Did this happen indoors or outdoors? If indoors, was it at home, school, work or another place? If outdoors, was it in your yard, on your street, along a road, at a school, in an agricultural field or other place?

  4. What did you see happen? For example: was the pesticide application nearby? Was there a spill or leak? Was the pesticide being sprayed, being mixed or transported? How far away were you? What type of equipment was used (tractor, hand-held or back pack sprayer). Did you see any dust or particles? What were the effects you experienced? Did you smell or taste anything unusual? Did anyone go to the hospital?

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