Product Evaluation Form

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Ministry of Agriculture
PRODUCT EVALUATION FORM - 2016
2% Liquid Strychnine Concentrate
Farmers, ranchers or Pest Control Officers must complete and submit this form in a timely fashion.
Please return the completed form to your RM office within 21 days of bait application.
Rural Municipality of:
, No.
Name:
Telephone #:(
)
(please print)
Mailing Address or P.O. Box #:
City, Town or Village:
Postal Code:
1) As part of an Integrated Pest Management (IPM) program, the following alternative methods to control
Richardson’s Ground Squirrels have been implemented:
Hunting____________
Trapping____________
Maintaining vegetative height (> 15 cm)_________
Raptor platforms____________
Maintaining Predator habitat__________
Other rodenticides
____________
Other control methods
(please list)
(please list)____________
2) Please complete the table below for each application.
Date
Date Bait
Legal Land
Land use:
Population
Approximate
Bait
Purchased
applied
Description or
Crop
Density at time
Area Treated
Performance
0 – 4
GPS coordinates
(crop type); or
of Application
(acres)
Poor
5 – 6
where bait was
Forage; or
(estimate # of
Fair
7 – 8
applied
Pasture
burrows/acre)
Good
9 – 10 Excellent
…2

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