Complaint form for the Assisted Human Reproduction Act

Privacy Notice

The information you provide in this complaint form, including personal information^{Footnote i}, is provided on a voluntary basis. The personal information is governed in accordance with the Privacy Act. We only collect the information we need to administer national compliance and enforcement activities under Health Canada's mandate authorized under the Assisted Human Reproduction Act (AHR Act) and its Regulations, including for investigations of offences under the AHR Act. Once collected, your personal information may be disclosed to the following entities: law enforcement (including, in particular, peace officers), other government institutions, as well as provincial, territorial, municipal governments or organizations, as well as their institutions, such as professional licensing or disciplinary bodies. In limited and specific circumstances, your personal information may be used and disclosed without your consent in accordance with subsection 8(2) of the Privacy Act.

Why are we collecting your personal information? We are requesting your personal information to be able to contact you for additional information regarding your complaint and/or for follow up, or for referral of your complaint to another organization outside Health Canada.

Will we use or share your personal information for any other reason? In limited and specific situations, your personal information may be disclosed without your consent in accordance with subsection 8(2) of the Privacy Act.

What happens if you do not want to provide your personal information? If you do not provide your personal information, in certain circumstances Health Canada may not be able to verify, follow-up or take action with respect to the complaint.

What are your rights? You have the right to access and request a correction and/or notation to your personal information. You also have a right to complain to the Privacy Commissioner of Canada if you feel your personal information has been handled improperly. For more information about these rights, or about how we handle your personal information, please contact the Biological Product Compliance Program at bpcp-pcpb@hc-sc.gc.ca

For more information: The collection of your personal information is described in Info Source at infosource.gc.ca.

General Information

Health Canada is committed to verifying complaints from Canadians and industry regarding materials, activities or any matters that are subject to the AHR Act, or its Regulations.

Materials subject to the AHR Act or its Regulations include, but are not limited to:

Donor sperm and eggs used for the purpose of assisted human reproduction (AHR)
In vitro embryos

Activities subject to the AHR Act or its Regulations include:

Processing, distributing, making use of and importing donor sperm or eggs for the purpose of AHR
Reimbursing sperm and egg donors for expenditures incurred in the course of donating
Reimbursing surrogate mothers for expenditures incurred by her in relation to her surrogacy
Reimbursing surrogate mothers for loss of work-related income incurred during her pregnancy
Reimbursing persons for expenditures related to the maintenance or transport of an in vitro embryo
Providing consent for the use of donated human reproductive material for the purpose of creating an embryo

Step 1: Information about you

First name

Last name

Business name, if applicable (use full legal name - no abbreviations)

Email (required)

Telephone

Language of correspondence (required)

Address (number and street)

City

Province or State

Postal code or Zip code

Country

Step 2: Who is the complaint about?

Name and last name or business name, if applicable (use full legal name - no abbreviations)

Telephone

Address (number and street)

City

Province or State

Postal code or Zip code

Country

Step 3: What is your complaint about?^{Footnote ii}

Tip: Click on footnote for clarification on what information to include.

Provide a brief description of the problem, incident, circumstances, or suspected violation of the AHR Act or its Regulations

If known, indicate when the incident occurred. (YYYY-MM-DD) (YYYY-MM-DD)

Was the complaint reported to the primary establishment^{Footnote iii}, importer, distributor, or other implicated party?

Note: Errors or accidents under the Safety of Sperm and Ova Regulations must be reported separately using the Sperm and ova error or accident investigation report form (FRM-0447).

Step 4: Supporting documentation

Do you wish to submit photographs or documents related to your complaint?

If yes, Health Canada will contact you with further instructions by phone or email.

Step 5: Consent

Please provide your consent by selecting Yes or No below. Providing consent facilitates verification of the compliance and the appropriate follow up and/or referral.

I authorize Health Canada to provide the contents of this form, including my contact information, to the primary establishment, importer, distributor, or other implicated regulated party, if necessary, to facilitate follow-up on my complaint by Health Canada and/or the primary establishment, importer, distributor, or other implicated regulated party. (required)

I authorize Health Canada to release the contents of this form, including the personal information to enforce the AHR Act and its Regulations for investigations of offences under the AHR Act. Your personal information may be disclosed to the following entities: law enforcement (including, in particular, peace officers), other government institutions, as well as provincial, territorial, municipal governments or organizations as well as their institutions, such as professional licensing or disciplinary bodies. (required)

Please note, that you are under no legal obligation to provide the information, and the information you provide may be used against you for the purpose of enforcing the AHR Act.

In limited and specific circumstances, your personal information may be used and disclosed without your consent in accordance with subsection 8(2) of the Privacy Act.

Once you submit the form, Health Canada will review the information and take appropriate actions, as required and as necessary, which may include following up with you directly.

All complaints are prioritized according to the health and safety risk with high-risk complaints receiving priority attention. Actions taken are consistent with the Compliance and Enforcement Policy for the Assisted Human Reproduction Act (POL-0100) with the objective of achieving compliance using the most appropriate level of intervention. Not all complaints will lead to further action from Health Canada.

If a complaint does not fall within our mandate, with the consent you have provided above, it may be directed to the appropriate authority or you will be provided with the appropriate authority to contact.

Please be sure to review your answers before you submit.

Footnotes

Footnote 1

Personal information is defined as information about an identifiable individual that is recorded in any form. Examples of personal information include an individual's name, address, postal code, race, religion, age, gender, date of birth, marital status, identifying numbers (e.g., Social Insurance Number), biometric information, genetic information, and personal opinions or views.

Return to footnote i referrer

Footnote 2

Include as much detail as possible when describing your problem or incident, for example information on what, when, where, who and how the problem or incident happened. Be sure to describe the AHR materials or activities to which your problem or incident pertains, as indicated above under "General Information."

Return to footnote ii referrer

Footnote 3

A primary establishment is an establishment that conducts all processing activities in respect of sperm or ova, whether it conducts them itself or another establishment conducts any of the activities on its behalf.

Return to footnote iii referrer

Page details

Date modified:: 2023-10-16

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Complaint form for the Assisted Human Reproduction Act

Privacy Notice

General Information

Step 1: Information about you

Step 2: Who is the complaint about?

Step 3: What is your complaint about?^{Footnote ii}

Step 4: Supporting documentation

Step 5: Consent

Footnotes

Page details

Complaint form for the Assisted Human Reproduction Act

Privacy Notice

General Information

Step 1: Information about you

Step 2: Who is the complaint about?

Step 3: What is your complaint about?Footnote ii

Step 4: Supporting documentation

Step 5: Consent

Footnotes

Page details

Step 3: What is your complaint about?^{Footnote ii}