Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3092

2. Registrant Information.

Registrant Reference Number: 10051801

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

Address: 5507 1st Street 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.

18-MAY-10

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

22-APR-10

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. 14726      PMRA Submission No.       EPA Registration No.

Product Name: 2,4-D Amine 600

• Active Ingredient(s)
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
  • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)

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

Product Name: Vantage

• Active Ingredient(s)
  • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)

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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: Industrial / Industriel

Préciser le type: along railway tracks

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

Application along the railway track - equipment was a truck mounted with a spray tank that had a 16 foot wide shrouded boom attached.

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.

Other

2. Demographic information of data subject

Sex: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Headache

• General
  • Symptom - Lightheadedness

• Respiratory System
  • Symptom - Coughing up blood

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

Unknown

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)

Unknown

10. Route(s) of exposure.

Unknown

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.)

Application was made April 22, 2010. Windspeed readings were recorded throughout the application and didn't reach more than 10 km/hr. A maintenance crew of three people were working 60-100 feet away from the application site. Maintenance crew complained of symptoms listed above. It is believed they sought medical attention.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

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

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Coughing up blood

• General
  • Symptom - Lightheadedness

• 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.

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Unknown

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)

Unknown

10. Route(s) of exposure.

Unknown

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.)

Application was made April 22, 2010. Windspeed readings were recorded throughout the application and didn't reach more than 10 km/hr. A maintenance crew of three people were working 60-100 feet away from the application site. Maintenance crew complained of symptoms listed above. It is believed they sought medical attention.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

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

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Headache

• General
  • Symptom - Lightheadedness

• Respiratory System
  • Symptom - Coughing up blood

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

Unknown

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)

Unknown

10. Route(s) of exposure.

Unknown

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.)

Application was made April 22,2010. Windspeed readings were recorded throughout the application and didn't reach more than 10km/hr. A maintenance crew of three people were working 60-100 feet away from the application site. Maintenance crew complained of symptoms listed above. It is believed they sought medical attention.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.