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NC Department of Health and Human Services
NC Division of Public Health
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Pesticides & Health

Reporting Illnesses & Injuries

How to Report

Choose one of 3 reporting methods:

  • Call the Carolinas Poison Center at 1-800-222-1222.
    This reporting method was created to save time and paperwork for health care providers. You may call here instead of calling N.C. Public Health. The Center operates 24/7 and is set up to collect all the required information. Professionals on staff can also help with pesticide toxicology information and medical management upon request.
  • Fax or mail a report to N.C. Division of Public Health (DPH), Occupational and Environmental Epidemiology Branch (OEEB), MSC 1912, Raleigh, NC 27699-1912; Fax: 919-870-4807 using the N.C. reporting form (DHHS 4077) (PDF or fillable PDF)*.
  • Call N.C. DPH, Occupational and Environmental Epidemiology (OEE) at 1-800-200-7090 or 1-919-707-5900

When to Report

  • Acute pesticide-related illness and injury within 48 hours
  • Acute pesticide-related illness and injury resulting in death – immediately

See our brochure on the Physician's Reporting Responsibilities Under State Public Health Law (PDF).

What to Report

Using the North Carolina reporting form (DHHS 4077) (PDF or fillable PDF)*, report the following:

  1. The name, address, telephone number, date of birth, race, ethnicity, gender, and occupation of the affected person;
  2. The physical location of the affected person at the time of exposure to the pesticide, if known (be as specific as possible and include address and telephone number);
  3. The name of the pesticide product and EPA registration number, if known; and
  4. The name, address, and telephone number of the physician or medical facility.

Who Should Report

Physicians, physician assistants, and nurse practitioners. Reports from exposed persons, witnesses and other concerned citizens will be accepted.

Confidentiality

Patients' names are confidential and are not released without consent. Only aggregate, non-identifying information is provided to the public.

Why Report?

Pesticide use is widespread, and potentially unhealthy for adults and children when products are not used as directed. The Pesticide Illness and Injury Surveillance Program monitors pesticide-related illness and injury, and receiving information from physicians is an important first step in the process. Reporting ensures that incidences are recorded and enhances prevention of pesticide-related illnesses. When we learn about your patient, we can offer resources to help prevent further exposure. Your reports also help Public Health to initiate investigations to identify factors contributing to hazardous exposures and to then make recommendations about safe handling practices. Through collaboration, we can help protect the health of those who live and work in our state.

 

*To download, you need to have Adobe Acrobat Reader. The PDF or the fillable PDF with the added content can be saved and faxed/mailed later.