Community Baiting Program Notification and Acknowledgement Form
A person who intends to use 1080 pest animal bait products must ensure that written notification is provided to all adjoining neighbours/occupiers of land which
adjoins the land on which the bait is to be laid (see Directions for the Use of Pest Animal Bait Products in Victoria for the definition of ‘adjoining neighbour’).
By signing this form the signatories acknowledge they have both received and provided notification of the intent to participate in the ………………………………………
baiting program.
Authorised 1080 bait users listed in the first column in the attached table will be participating in the above community baiting program to control foxes or wild dogs or feral
pigs or rabbits (cross out inappropriate species).
The poison to be used is compound 1080 (sodium fluoroacetate). Baiting will occur from………………………… to ………………………………..(dd/mm/yy) after which time
bait users will collect and dispose of untaken and unused baits in accordance with the Directions for the Use of 1080 Pest Animal Bait Products in Victoria. The use of the
1080 pest animal bait products will comply with the product label and the Directions for the Use of 1080 Pest Animal Bait Products in Victoria.
To minimise the risk of poisoning to non-target animals you are advised:
1.You should take all the necessary precautions to confine, muzzle and / or restrain your domestic animals, particularly dogs and cats, to prevent them from accessing 1080
pest animal poison baits or carcasses. Domestic animals are susceptible to primary poisoning from ingesting 1080 pest animal bait products and secondary poisoning from
ingesting poisoned carcasses.
2. Collect and destroy any poisoned carcasses you find by burning (in accordance with local regulations) or burying to a depth of at least 50 cm for rabbits and at least 1
metre for foxes, wild dogs and feral pigs.
3. Always dispose of carcasses away from natural features such as waterways.
Danger to humans:
Compound 1080 (sodium fluoroacetate) is a restricted Schedule 7 poison and there is no known antidote. If you are handling poison bait and/or carcasses always use
protective rubber gloves and wash hands and gloves thoroughly after contact.
If poisoning occurs immediately contact a doctor or the Poisons Information Centre on 13 11 26
Further information on the use and handling of 1080 is available from 1080 pest animal bait manufacturers.
Bait users must make records of neighbour notification within 48 hours of notification and keep these records for 2 years.
Community Baiting Program Notification and Acknowledgement Form
Bait user’s name:
Joe Blogs
(example only)
Bill Smith
(example only)
Bait type and
target species:
Location/address where the
baits are to be laid:
Bait user’s contact
details:
Signature to confirm that I
have notified the
signatories as listed on
this form:
Signature to confirm that I
have been notified of
planned baiting by my
neighbours listed on this
form:
Foxoff / foxes
1275 Sugarloaf Rd, Boort
03 55 123 456
Joe Blogs
Bill Smith
Foxoff / foxes
633 Deep Creek Rd ,Boort
03 55 123 265
Bill Smith
Joe Blogs
Community Baiting Program Notification and Acknowledgement Form
Bait user’s name:
Bait type and
target species:
Location/address where the
baits are to be laid:
Bait user’s contact
details:
Signature to confirm that I
have notified the
signatories as listed on
this form:
Signature to confirm that I
have been notified of
planned baiting by my
neighbours listed on this
form: