Pesticide Reporting Form for Providers
It’s the law!
Pursuant to N.C. 10A NCAC 41F .0101-.0103, physicians (to include physician assistants and nurse practitioners) are required to report confirmed or suspected cases of acute pesticide-related illness or injury within 48 hours of diagnosis, immediately for cases resulting in death.
All information reported is considered confidential, and identifying information is protected within the confidentiality guidelines for the Epidemiology Section, NCDHHS. Physicians may call Carolinas Poison Center to report a case to fulfill reporting requirements at 1-800-222-1222, option 5.
The North Carolina Pesticide Illness and Injury Surveillance Program monitors pesticide-related illness and injury. Reporting ensures that incidents are recorded and enhances the prevention of pesticide-related illnesses and injuries. The reports may initiate investigations to identify factors contributing to hazardous exposures and then make recommendations about safe handling practices. Learn more about how and when to report pesticide-related illness and injury.