Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-3958

2. Registrant Information.

Registrant Reference Number: N/A

Registrant Name (Full Legal Name no abbreviations): Ashland Canada Corp.

Address: 2620 Royal Windsor Drive

City: Mississauga

Prov / State: Ontario

Country: Canada

Postal Code: L5J 4E7

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

Human

4. Date registrant was first informed of the incident.

04-JUL-11

5. Location of incident.

Country: CANADA

Prov / State: NEW BRUNSWICK

6. Date incident was first observed.

01-JUN-11

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. 24506      PMRA Submission No.       EPA Registration No.

Product Name: SPECTRUM RX3100 MICROBIOCIDE

• Active Ingredient(s)
  • DODECYLGUANIDINE HYDROCHLORIDE
  • METHYLENE BIS(THIOCYANATE)

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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.

Other

2. Demographic information of data subject

Sex: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Irritated skin

4. How long did the symptoms last?

>30 min <=2 hrs / >30 min <=2 h

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)

Other

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

Long-sleeve shirt

Long pants

Goggles

Chemical resistant gloves

10. Route(s) of exposure.

Skin

11. What was the length of exposure?

<=15 min / <=15 min

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.)

Employee was splashed on left arm, and product leaked under glove. Most of product was on forearm, wrist and hand. Employee rinsed affected area immediately for approx. 30 minutes. Visited local hospital for examination, and released without treatment, prescription or restrictions. Advised to apply moisturizer if skin irritated.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Root cause analysis of incident revealed lack of familiarity with equipment (employee was filling in for someone else). Redesign of system to be considered. Improved PPE recommendations for working with this material.