Spray Drift Report

C4EP: Citizens for Environmental Protection

A Grassroots Group Dedicated to an Organic, Natural and Sustainable Environment

IF YOU FEEL ILL FROM TOXIC POISONING DO NOT HESITATE TO SEEK MEDICAL ATTENTION!

If you wish, fill out the form below and make a copy of it for your records. If you wish to send the report to Citizens for Environmental Protection, click the submit button when you are through. All fields are optional, but as many as you include will benefit the documentation and help in keeping track of chemical trespass events to assist in protection efforts by C4EP. You may also wish to file a police report on the occurrence. Chemical trespass is against the law! If you can film or photograph an incident without endangering yourself, that evidence is always helpful. Testing for pesticides is expensive, and you will need to know what was applied to test for it. The applicator may or may not co-operate with your inquiry. Be careful! It is not uncommon to be met with violence in trying to protect oneself and land. The act of chemical trespass is a violent act against one's airspace and land and body. Children and the elderly are especially vulnerable, as well as people with allergies and illnesses. What to do after the report (see below)

Would you like C4EP to contact you?

When you have completed the form Please remember to click the submit button. If you do not know the answer to a question please type "unknown"

To erase information and reset the form to begin again, please click the reset button.

FOLLOW UP

Keep a list of who you reported the incident to.

Keep the report (and copies of police reports, legal papers etc.) in a secure location.

Add photos and video tape. Label everything with the date.

You have every right to seek legal counsel and to protect yourself from chemical trespass and to bring a lawsuit for damages. Courts need evidence. Your documentation is important, as well as police reports etc.

Chemical Tresspass Violation Form Contact Information: Your name: Your address: Your phone: Your email address: Date of the Occurance: Location of the occurance: Name of spray drift applicator: Was this an agribusiness? Chemical(s) used: Witnesses: Wind speed and direction: Details of the chemical tresspass incident (Please be specific. Tell how it happened, and list the victims, environmental impacts, human health impacts etc.):

YES
NO