Cannabis Reporting Form

Privacy Notice Statement

The personal information you provide is protected in accordance with the Privacy Act and is collected under the authority of Section 4 of the Department of Health Act. Your contact information is being collected to enable Health Canada to follow up with you regarding your report and may be used to initiate an investigation, authorized under Part 7 of the Cannabis Act. The information that you provide, including your name and contact information may be provided to the party subject to this report or to provincial, territorial or federal regulatory agencies in order to address the matter you have raised. To safeguard privacy, please ensure that you limit the amount of personal information you provide in the text of your report. For more information please refer to the personal information bank Public Communications PSU 914 at www.infosource.gc.ca. You have the right to access your personal information and correct any incorrect information. You have the right to file a complaint with the Privacy Commissioner of Canada if you think your personal information has been handled improperly. For details regarding the handling of your personal information, please contact Health Canada’s Privacy Management Division at hc.privacy-vie.privee@canada.ca.

Information about who is reporting

Please include details about yourself in this section

Please copy and paste the full website URL.

Health Canada may contact you to obtain additional details or clarification about the information you are submitting.

Reason for report

You have selected that this report is associated with a side effect (also known as an adverse reaction). As such, after completion of this cannabis reporting form, a link will direct you to the Health Canada's Adverse Reaction Reporting web page to report an adverse reaction.

Please provide a sufficient description of the cannabis issue that you are experiencing.
Cannabis product or accessory

Enter the product or accessory details and information regarding the party that sold or distributed the cannabis product or accessory as well as where it was purchased. This information can be found on the label of the cannabis product or accessory. To enter additional products or accessories, click on the "Add product/accessory" button. To remove one product and its related information, click on the "Remove product/accessory" button.

Cannabis product (opens new window) means cannabis of only one of the classes that are set out in Schedule 4 (opens new window) to the Cannabis Act – or a cannabis accessory if that accessory contains such cannabis – after it has been packaged and labelled for sale to a consumer at the retail level, but does not include a drug containing cannabis.

Cannabis accessory (opens new window) means

  1. a thing, including rolling papers or wraps, holders, pipes, water pipes, bongs and vaporizers, that is represented to be used in the consumption of cannabis; or
  2. a thing commonly used in the consumption of cannabis that is sold at the same point of sale as cannabis.
To add another product or accessory please return to Product or accessory section above
Information regarding the Party Subject to this report

If this report is related to a specific cannabis product or accessory, this information can be found on the label of the cannabis product or accessory.

If this report is associated to a site related to cannabis, a service related to cannabis, a promotion/advertising/marketing related to cannabis, or other, please provide as much information as possible as it relates to the subject of the report.

Please copy and paste the full website URL.
Where was the cannabis product or accessory purchased?

Documents and pictures

Please upload any additional information that you wish to include in the Cannabis Reporting Form.

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