Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-0834

2. Registrant Information.

Registrant Reference Number: DAS-090310

Registrant Name (Full Legal Name no abbreviations): Dow AgroSciences Canada Inc.

Address: Suite 2100, 450 - 1 Street S.W.

City: Calgary

Prov / State: Alberta

Country: Canada

Postal Code: T2P 5H1

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

15-SEP-08

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

Unknown

Product Description

7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.

Active(s)

---

PMRA Registration No. 28434      PMRA Submission No.       EPA Registration No.

Product Name: Garlon Ultra

• Active Ingredient(s)
  • TRICLOPYR

---

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Industrial / Industriel

Préciser le type: near (city)

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Ground spraying for foliar application.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

No

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Medical Professional

2. Demographic information of data subject

Sex: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Irritated skin
  • Symptom - Rash
  • Symptom - Inflammation of the skin

• Eye
  • Symptom - Swollen eye

• Gastrointestinal System
  • Symptom - Irritated throat

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Occupational

8. How did exposure occur? (Select all that apply)

Application

Drift from the application site

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Long pants

10. Route(s) of exposure.

Skin

Eye

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

Dr.(name) conclusion is that: Two applicators suffered allergic skin reactions to Triclopyr (skin irritations, rashes, swollen eyes, irritated throat). Both workers had significant exposures to Triclopyr. One had been sprayed in the face (wind direction change) and experienced a sudden onset of symptoms (skin allergy) and was treated with cortisone cream while hospitalized. His recommendations: 1) These two workers should not have direct contact with Triclopyr (they risk another allergic skin reaction). 2) All safety precautions must be taken by applicators. He understands that this reaction occurred because the applicators were exposed more than they should have been and that it is related to the type of application equipment used.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

Dow AgroSciences was alerted on September 15/08 that a possible incident had occurred in (location). We were unable to effectively report this incident immediately for several reasons: No details of the incident except notification were provided; delayed communication from the employer of the affected workers; conflicting information on who was affected; and the length of time required for the doctor to make an assessment and report back to Dow AgroSciences.

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Medical Professional

2. Demographic information of data subject

Sex: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Irritated skin
  • Symptom - Rash
  • Symptom - Inflammation of the skin

• Eye
  • Symptom - Swollen eye

• Gastrointestinal System
  • Symptom - Irritated throat

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Occupational

8. How did exposure occur? (Select all that apply)

Application

Drift from the application site

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Long pants

10. Route(s) of exposure.

Skin

Eye

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

Dr. (name) conclusion is that: Two applicators suffered allergic skin reactions to Triclopyr (skin irritations, rashes, swollen eyes, irritated throat). Both workers had significant exposures to Triclopyr. The second one had significant clothing contamination (clothes not changed). His recommendations: 1) These two workers should not have direct contact with Triclopyr (they risk another allergic skin reaction). 2) All safety precautions must be taken by applicators. He understands that this reaction occurred because the applicators were exposed more than they should have been and that it is related to the type of application equipment used.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

Dow AgroSciences was alerted on September 15/08 that a possible incident had occurred in (location). We were unable to effectively report this incident immediately for several reasons: No details of the incident except notification were provided; delayed communication from the employer of the affected workers; conflicting information on who was affected; and the length of time required for the doctor to make an assessment and report back to Dow AgroSciences.