Freshwater/land-based aquaculture licence under the Fisheries Act - Appendix V: Urgent notification (& 10-day follow-up report) of mortality

This webpage is intended for informational purposes only.

Please email to:

Reporting date and time of this emergency notification:

Farm name and Facility Reference number:

Contact Name:

Phone Number:

Circle the event(s) that occurred which requires immediate attention:

Unusually high fish mortalities (if so – attributed to)
Vet or Lab Diagnosis of Disease Listed in Appendix III (identify pathogen)
Infectious Outbreak (i.e elevated losses) (identify pathogen)
Emergency Fish Health Response required Y / N (if yes – was DFO notified as per licence conditions Y / N )

Part C.
The following details of are to be completed for each individual fish health event:


Date that event was discovered:

Cause and/or Diagnosis:

ID or Lot # (of affected fish):




Fish Species and Common Names:


Number of Fish on Site (pieces):


Were treated fish mixed in with non-treated fish?

Y / N

Estimated mortalities (numbers, volume)

Over ____ (number) days

Recent Escape from lot during reporting period?

Y / N

Harvest from lot during reporting period?

Y / N

1. Name of Drug and Prescription No. (if any)


2. Date Treatment Commenced


3. Date Treatment Ended


4. Treatment Information (withdrawal time prescribed, how applied to animals (in-feed or bath), amount per Kg of feed, etc.) / Response description




Treatment file and details are available at rearing site:

5. Name of Prescribing Veterinarian

6. Name of Person Responsible for Administering the Treatment


Signature of Person Responsible for the information of this declaration