Report and Response Information
Complaint Report Date
(Required)
MM
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
YYYY
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Compliant Report Type
(Required)
Phone Call
Email
Text Message
Other
MDAR Response Date
(Required)
MM
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
YYYY
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
MDAR Response Type
(Required)
Phone Call
Email
Text Message
Other
MDAR Inspector Who Responded
(Required)
Kim Skyrm, Ph.D.
Paul Tessier
Rhys Willette
Jessica Glover
Mike McClean
Laurie Manning
Clayton Edwards
Fred Oakes
Mark Herlihy
Jacob Murzyn
Beekeeper Information
Name
(Required)
First
Last
Home/Cell
(Required)
Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Email
County
(Required)
Apiary Information
Apiary #
Apiary Name
Apiary address is the same as above
Yes
Apiary Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Apiary Type / Totals
Overwintered Colony
Package
Nuc
Swarm
Split
Other
Apiary Management
Colony Treatment(s) Performed within Last Year
Last Varroa Mite Count/Method/Date(s
Additional Notes About the Apiary or Beekeeper
Compliant Information
Incident Details
Date(s) Incident Was Detected
(Required)
Date(s) of Last Beekeeper Inspection
(Required)
Apiary Type / Totals Impacted
(Required)
Current Quantity of Dead/Dying Bees
Description of Incident
(Required)
Current Vitality Status / Bee Behavior Observed in Apiary
(Required)
Beekeeper Suspected Cause of Incident
(Required)
History of Similar Incidents to MDAR
(Required)
Pesticide Applications
Date(s) of Area Pesticide Applications
Pesticide Application(s) Details
Additional Notes About the Incident
Future MDAR Action
Recommend for Bee Kill Investigation?
(Required)
Yes
No
Anticipated Investigation Team
Apiary
Apiary and Pesticide
Apiary Inspector Assigned to Investigation (tentative)
Kim Skyrm, Ph.D.
Paul Tessier
Rhys Willette
Jessica Glover
Pesticide Inspector Assigned to Investigation (tentative)
Mike McClean
Laurie Manning
Clayton Edwards
Mark Herlihy
Fred Oakes
Jacob Murzyn
Tentative Date for Scheduled Inspection
Contact Information for Area Beekeepers