Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-2822

2. Registrant Information.

Registrant Reference Number: PROSAR Case#:1-33330333

Registrant Name (Full Legal Name no abbreviations): Scotts Canada Ltd.

Address: 2000 Argentia Road, Plaza 5, Suite 101

City: Mississauga

Prov / State: Ontario

Country: Canada

Postal Code: L5N2R7

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

Human

4. Date registrant was first informed of the incident.

17-APR-13

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

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.       PMRA Submission No.       EPA Registration No. 2009025C

Product Name: Turf Builder Lawn Fertilizer 10-0-0 with Weed Prevent

• Active Ingredient(s)
  • CORN GLUTEN MEAL

---

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: Female

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Irritated nose

• Nervous and Muscular Systems
  • Symptom - Headache

• Gastrointestinal System
  • Symptom - Irritated throat

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.

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)

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.

Respiratory

11. What was the length of exposure?

>3 days <=1 wk / >3 jours <=1 sem

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.)

1-33330333 - The reporter, an employee at Costco , indicated that she and three other co-workers were exposed to a fertilizer containing the active ingredient corn gluten meal. The reporter indicated that two pallets with this bagged product and another non-registered lawn fertilizer were placed near her work area four days prior to initial contact with the registrant. The reporter states that both her (Subform II #1) and 3 other co-workers (Subform II #2 through 4) have been suffering from an irritated nose, an irritated throat and from headaches since the product was placed near their work area. The symptoms improve when the reporter or her co-workers move away from their work area. The reporter was advised that inhalation of fumes may cause transient respiratory irritation. Moving the product away from the optometry department to prevent further exposure to the fumes was recommended. On call back, one day later, the reporter indicated that the product had been moved to another area and symptoms had resolved. No further information was available.

To be determined by Registrant

14. Severity classification.

Minor

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: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Irritated nose

• Gastrointestinal System
  • Symptom - Irritated throat

• Nervous and Muscular Systems
  • Symptom - Headache

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.

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)

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.

Respiratory

11. What was the length of exposure?

>3 days <=1 wk / >3 jours <=1 sem

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.)

1-33330333 - The reporter, an employee at Costco, indicated that she and three other co-workers were exposed to a fertilizer containing the active ingredient corn gluten meal. The reporter indicated that two pallets with this bagged product and another non-registered lawn fertilizer were placed near her work area four days prior to initial contact with the registrant. The reporter states that both her (Subform II #1) and 3 other co-workers (Subform II #2 through 4) have been suffering from an irritated nose, an irritated throat and from headaches since the product was placed near their work area. The symptoms improve when the reporter or her co-workers move away from their work area. The reporter was advised that inhalation of fumes may cause transient respiratory irritation. Moving the product away from the optometry department to prevent further exposure to the fumes was recommended. On call back, one day later, the reporter indicated that the product had been moved to another area and symptoms had resolved. No further information was available.

To be determined by Registrant

14. Severity classification.

Minor

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: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Irritated nose

• Gastrointestinal System
  • Symptom - Irritated throat

• Nervous and Muscular Systems
  • Symptom - Headache

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.

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)

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.

Respiratory

11. What was the length of exposure?

>3 days <=1 wk / >3 jours <=1 sem

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.)

1-33330333 - The reporter, an employee at Costco, indicated that she and three other co-workers were exposed to a fertilizer containing the active ingredient corn gluten meal. The reporter indicated that two pallets with this bagged product and another non-registered lawn fertilizer were placed near her work area four days prior to initial contact with the registrant. The reporter states that both her (Subform II #1) and 3 other co-workers (Subform II #2 through 4) have been suffering from an irritated nose, an irritated throat and from headaches since the product was placed near their work area. The symptoms improve when the reporter or her co-workers move away from their work area. The reporter was advised that inhalation of fumes may cause transient respiratory irritation. Moving the product away from the optometry department to prevent further exposure to the fumes was recommended. On call back, one day later, the reporter indicated that the product had been moved to another area and symptoms had resolved. No further information was available.

To be determined by Registrant

14. Severity classification.

Minor

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: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Irritated throat

• Respiratory System
  • Symptom - Irritated nose

• Nervous and Muscular Systems
  • Symptom - Headache

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.

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)

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.

Respiratory

11. What was the length of exposure?

>3 days <=1 wk / >3 jours <=1 sem

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.)

1-33330333 - The reporter, an employee at Costco, indicated that she and three other co-workers were exposed to a fertilizer containing the active ingredient corn gluten meal. The reporter indicated that two pallets with this bagged product and another non-registered lawn fertilizer were placed near her work area four days prior to initial contact with the registrant. The reporter states that both her (Subform II #1) and 3 other co-workers (Subform II #2 through 4) have been suffering from an irritated nose, an irritated throat and from headaches since the product was placed near their work area. The symptoms improve when the reporter or her co-workers move away from their work area. The reporter was advised that inhalation of fumes may cause transient respiratory irritation. Moving the product away from the optometry department to prevent further exposure to the fumes was recommended. On call back, one day later, the reporter indicated that the product had been moved to another area and symptoms had resolved. No further information was available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.