Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-1568

2. Registrant Information.

Registrant Reference Number: 495-01

Registrant Name (Full Legal Name no abbreviations): ISP CANADA CORP.

Address: 4055 Sladeview Crescent, Unit #7

City: Mississauga

Prov / State: ON

Country: Canada

Postal Code: L5L 5Y1

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

Human

4. Date registrant was first informed of the incident.

05-NOV-08

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

16-OCT-08

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)

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PMRA Registration No. 28158      PMRA Submission No.       EPA Registration No.

Product Name: NUOSEPT 495 PRESERVATIVE

• Active Ingredient(s)
  • 1,2-BENZISOTHIAZOLIN-3-ONE

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7. b) Type of formulation.

Application Information

8. Product was applied?

No

9. Application Rate.

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

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

To be determined by Registrant

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

Unknown

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

1. Source of Report.

Data Subject

2. Demographic information of data subject

Sex: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Rash

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

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)

Other

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

Goggles

Chemical resistant gloves

Chemical resistant coveralls

Respirator

10. Route(s) of exposure.

Skin

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.)

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Rash occurred following charging the BIT (active) to the reactor. The BIT originally used was 72% and no problems existed - rash occurred only after beginning use of the 84% a.i. There were 2 workers involved - both male - and both following the same procedure - on different days. Both wore full face respirator, gloves and chemical resistant suit - however - neck was exposed while charging the material - rash developed on neck of both. The Lab Manager also noted a rash on the front of her neck after testing the BIT in the lab. She wore a lab coat and gloves and worked with the material in the hood.