Selenium-containing Substances Reporting Form Published in the Canada Gazette on May 25, 2013

(Excel Format - Part 1 – Questions - 137 KB)
(PDF Format - Part 2 – Declaration Signature Page - 22 KB)

Table of Contents

• Part 1 – Questions
  • Introduction
  • Schedule 1
  • Schedule 2
  • Identification
  • Schedule 3, Section 5
  • Schedule 3, Section 6
  • Schedule 3, Section 7
  • Schedule 3, Section 8
  • Schedule 3, Section 9
• Part 2 – Declaration Signature Page

Part 1 – Questions

Introduction

You may respond to the Selenium-containing substances section 71 Notice using the Selenium-containing Substances Reporting Form. Please note that there are 2 parts to the Selenium Reporting Form that must be filled out and submitted in order for the response to be considered complete:

1. Selenium-containing Substances Reporting Form Part 1 – Questions (Submit the Excel format):
   Please complete the applicable sections, as outlined in Schedule 2 to the Notice. The sections of the Notice can be accessed using the tabs below.
   
   Note that respondents are encouraged to complete and submit the Selenium-containing Substances Reporting Form- Part 1 in Excel format, either by email or electronically (via CD, DVD or USB memory stick).
   
2. Selenium-containing Substances Reporting Form Part 2 – Declaration Signature Page (Submit the PDF format):
   In addition to completing Part 1 of the Selenium-containing Substances Reporting Form, you must also complete and sign the Selenium- containing Substances Reporting Form Part 2- Declaration Signature Page to declare that the information being submitted is accurate and complete.
   
   Note that the signed Selenium-containing Substances Reporting Form- Part 2 may be submitted via email, mail or fax.

Please refer to the Selenium-containing Substances Guidance Document for assistance in completing the section 71 Notice.

Provide the information no later than October 1, 2013, 5 p.m. Eastern Daylight Saving Time to:

Minister of the Environment, to the attention of the Substances Management Coordinator, Chemicals Management Plan
200 Sacré-Cœur Boulevard, Gatineau QC K1A 0H3
Email: Substances@ec.gc.ca
Telephone: 1-800-567-1999 (toll free in Canada) or 819-953-7156 (outside of Canada)
Fax: 1-819-953-7155
Website: Chemical Substances

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Schedule 1

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Schedule 2

Persons Required to Provide Information

1. This notice applies to any person who, during the 2012 calendar year, imported a total quantity greater than 100 kg of a substance listed in Schedule 1 to this notice, at a concentration equal to or above 0.001 percent by weight (w/w %), whether in:
   • (a) a mixture or in a product, intended to be used in a residence, that is:
     • (i) a polish, paint, coating, ink, adhesive or sealant;
     • (ii) for cleaning or for fabric care;
   • (b) a mixture or product intended to clean floors or food preparation surfaces; or
   • (c) a toy intended to be used by children under the age of six years.
2. This notice applies to any person who, during the 2012 calendar year, used a total quantity greater than 100 kg of a substance listed in Schedule 1 to this notice, whether alone; or at a concentration equal to or above 0.001 percent by weight (w/w %) in a mixture or in a product:
   • (a) in the manufacture of  a mixture or a product, intended to be used in a residence, that is:
     • (i) a polish, paint, coating, ink, adhesive or sealant;
     • (ii) for cleaning or for fabric care;
   • (b) in the manufacture of a mixture or product intended to clean floors or food preparation surfaces; or
   • (c) in the manufacture of a toy intended to be used by children under the age of six years.
3. This notice does not apply to the substance set out in Schedule 1, whether alone, in a mixture or in a product that:
   • (a) is in transit through Canada; or
   • (b) is, or is contained in, a pest control product within the meaning of subsection 2(1) of the Pest Control Products Act where that pest control product is registered under the Pest Control Products Act.
4. Respondents to this notice who:
   • (a) imported a substance listed in Schedule 1 shall complete sections 4, 5, and 7 in Schedule 3; or
   • (b) used a substance listed in of Schedule 1 shall complete sections 4, 5, 6, and 7 in Schedule 3.

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Identification

Note: The Selenium Reporting Form Part 2 - Declaration Signature Page must also be submitted in order for the response to be considered complete.

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Schedule 3, Section 5

5. (1) For each substance listed in Schedule 1 that a person imported or used during the 2012 calendar year, for which the criteria set out in Schedule 2 have been met, the person shall provide the following information: 

• (a) the CAS RN of the substance; 
• (b) the applicable Consumer and Commercial Code(s), set out in section 8;
• (c) for each applicable Consumer and Commercial Code, the total quantity of the substance reported in kilograms (rounded to 2 significant digits);  
• (d) for each applicable Consumer and Commercial Code, the description and the common or generic name of the known or anticipated final mixture, product or manufactured item containing the substance;
• (e) for each applicable Consumer and Commercial Code, the concentration, or range of concentrations, of the substance by weight (w/w%) in the known or anticipated final mixture, product or manufactured item containing the substance.

5. (2) Where code C999 is applicable for paragraph (1)(b), a written description of the mixture, product or manufactured item must be provided.

Continuation

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Schedule 3, Section 6

6. (1) For each substance listed in Schedule 1 that a person used during the 2012 calendar year, for which the criteria set out in Schedule 2 have been met, the person shall provide the following information:

• (a) the CAS RN of the substance;
• (b) the applicable Substance Function Code(s) set out in section 9 that apply to the substance; and
• (c) for each applicable Substance Function Code, the total quantity of the substance used reported in kilograms (rounded to 2 significant digits).

6. (2) Where code U999 is applicable for paragraph (1)(b), a written description of the substance function must be provided.

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Schedule 3, Section 7

7. For each substance listed in Schedule 1 that a person imported or used during the 2012 calendar year, for which the criteria set out in Schedule 2 have been met, the person shall provide the following information from any calendar year:

• (a) the CAS RN of the substance;
• (b) any unpublished data or studies, with a dosing duration of less than two weeks, with regards to the human health endpoint acute mammalian toxicity;^[2] and
• (c) the study title(s) for the data or studies submitted in paragraph (b).

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Schedule 3, Section 8

8. For the purpose of section 5, the following table sets out the Consumer and Commercial Codes and their corresponding descriptions:

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Schedule 3, Section 9

9. For the purposes of section 6, the following are the Substance Function Codes and their corresponding descriptions:

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Footnote