Global Adverse Effects Reporting Form

Use this form to report to Dow AgroSciences any alleged or actual product complaint, incident, issue or concern involving exposure or injury to humans, animals or the environment related to the use of a Dow AgroSciences product in countries where it conducts business. The form must be completed within 72 hours of the employee or DAS agent being made aware of such information or incident. Exception: An incident or information involving a human death allegation must be reported immediately!

If you receive additional information or incident details after submitting the initial form, please complete a separate Global Adverse Effects Reporting Form and forward within 72 hours of receipt of the new information.

This form must be submitted in English.

  1. You do not need to submit this form unless you have, at a minimum:
    1. Information about the location where the incident occurred,
    2. The name of the pesticide(s) or product(s) involved, and
    3. The name and phone number of the person to contact regarding the incident.
  2. Fill out the forms as completely as possible.
  3. To submit additional documentation please include attachment(s) in an email to

Global Adverse Effects Reporting Coordinator
Global Product Stewardship and Sustainability
Telephone: +1-317-337-4577

Dow AgroSciences
9330 Zionsville Road
Indianapolis, IN 46268 USA
Attn: Global Adverse Effects Reporting Coordinator


Section 1. Administrative Data
Section 2. Product(s) Involved
Section 3. Incident Information