Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-2447

2. Registrant Information.

Registrant Reference Number: 09062501

Registrant Name (Full Legal Name no abbreviations): Nufarm Agriculture Inc

Address: 5507 1st St SE

City: Calgary

Prov / State: Alberta

Country: Canada

Postal Code: T2H 1H9

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

Human

4. Date registrant was first informed of the incident.

25-JUN-09

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

25-JUN-09

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. 26999      PMRA Submission No.       EPA Registration No.

Product Name: Mextrol 450 Liquid Herbicide

• Active Ingredient(s)
  • BROMOXYNIL
  • MCPA (PRESENT AS ESTERS)

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PMRA Registration No. 27011      PMRA Submission No.       EPA Registration No.

Product Name: Achieve Liquid Herbicide

• Active Ingredient(s)
  • TRALKOXYDIM

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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: Unknown / Inconnu

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

Caller was unsure of what to do - he soaked himself in chemical this morning by accident while applying the product and was wondering if a shower and a change of clothes is all that is required. He was instructed to immediately call Prosar - (phone #). As agreed, after calling Prosar, he called back and said he felt okay, just was having a headache that he has had for the last couple of days while applying the chemical.

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: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Headache

4. How long did the symptoms last?

Unknown / Inconnu

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

No

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

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

Unknown

10. Route(s) of exposure.

Skin

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

Headache for past few days while applying chemical; stronger today when chemical was spilled on him. Prosar told him to take a shower and change his clothes, also explained about the products' toxicity, pH and possible adverse effects.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.