Freshwater/land-based aquaculture licence under the Fisheries Act - Appendix VI: Escape notification form

This webpage is intended for informational purposes only.

Please report all escapes upon discovery

Company information

Company:

Facility Name:

Address:

Contant Name:

Phone Number:

Email:

Report Date:

File numbers

ORR #:

Facility Reference#:

Report of escape incident

  • Suspected escape (date/ time):
  • Species of finfish:
  • Date Stocked:
  • Estimated number of escaped fish:
  • Average weight of escaped fish:
  • Name of facility where fish were produced:

List any therapeutants (still within the prescribed withdrawal period) administered to these finfish:

  • Name of drug(s):
  • Period of administration, including dates of commencement and completion of drug treatment:
  • Name of prescribing veterinarian:
  • The prescribed withdrawal period:
  • Identification of the groups/pen #s of finfish treated:

Description of event

Describe in detail the cause or suspected cause of incident:


 

Describe in detail measures that will be implemented to prevent future incidents:


 

Additional comments:


 

Submitted by:

 

Signature

 

Please Print Name

 

Date:

 

SUBMIT the completed form to Fisheries & Oceans Canada inbox: AQFF.FishEscapes@dfo-mpo.gc.ca