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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2014-2182
2. Registrant Information.
Registrant Reference Number: DASC140502-00
Registrant Name (Full Legal Name no abbreviations): Dow AgroSciences Canada Inc.
Address: Suite 2100, 450-1st Street S.W.
City: Alberta
Prov / State: Calgary
Country: Canada
Postal Code: T2P 5H1
3. Select the appropriate subform(s) for the incident.
Human
Domestic Animal
Environment
4. Date registrant was first informed of the incident.
12-MAY-145. Location of incident.
Country: CANADA
Prov / State: BRITISH COLUMBIA
6. Date incident was first observed.
02-MAY-14Product 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. 28945 PMRA Submission No. EPA Registration No.
Product Name: Garlon XRT
- Active Ingredient(s)
- TRICLOPYR
PMRA Registration No. 29994 PMRA Submission No. EPA Registration No.
Product Name: Vantage XRT
- Active Ingredient(s)
- GLYPHOSATE (PRESENT AS DIMETHYLAMINE SALT)
PMRA Registration No. 23713 PMRA Submission No. EPA Registration No.
Product Name: Arsenal
- Active Ingredient(s)
- IMAZAPYR
PMRA Registration No. 29232 PMRA Submission No. EPA Registration No.
Product Name: Payload
- Active Ingredient(s)
- FLUMIOXAZIN
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
4Units: L/ha
10. Site pesticide was applied to (select all that apply).
Site: Industrial / Industriel
Préciser le type: Right-of-way
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
A licensed applicator sprayed a rail balast with Payload, Vantage XRT and Arsenal, and then sprayed the railway bed with Garlon XRT, On-Site and Halt when the alleged drift occured onto 6 blueberry farms.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 - Rash
- Respiratory System
- Symptom -
- Specify - Throat constricted
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?
Unknown
6. b) For how long?
7. Exposure scenario
Non-occupational
8. How did exposure occur? (Select all that apply)
Drift from the application site
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
Respiratory
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.)
Caller stated she had a rash all over her hands and that she felt that her throat was constricted.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Bird - Poultry / Oiseau - Volaille
3. Breed
Chickens
4. Number of animals affected
0
5. Sex
Unknown
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Respiratory
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- General
- Symptom - Death
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Unknown
14. a) Was the animal hospitalized?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Died
16. How was the animal exposed?
Spray drift / Dérive de pulvérisation
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
Caller stated that 5% of their chickens in both chicken barns died two days after the alleged spray drift.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Subform IV: Environment (includes plants insects and wildlife)
1. Type of organism affected
Trees or shrubs / Arbre ou arbuste
2. Common name(s)
blueberries
3. Scientific name(s)
Unknown
4. Number of organisms affected
Unknown
5. Description of site where incident was observed
Fresh water
Terrestrial
Other
Salt Water
6. Check all symptoms that apply
Abnormal leaf discoloration
7. Describe symptoms and outcome (died, recovered, etc.).
Drift occurred onto 6 blueberry farms. One farm looked to be more affected as it had more browning leave spots. For a few of the farms, it was more difficult to find the spots on the blueberry leaves. Blueberry bushes in all 6 farms were showing some new growth.
8. a) Was the incident a result of (select all that apply)
Drift
N/A
8. b) i) How many times has the product been applied this year?
8. b) ii) What was the date of the last application?
9. Did it rain
9. a) During application?
No
9. b) Up to 3 days after application?
No
10. a) Was there a buffer zone?
No
10. b) What type?
10. c) What was the size of the buffer zone?
11. a) Were environmental samples collected and analysed?
No
To be determined by Registrant
12. Severity classification (if there is more than one possible classification, select the most severe)
Minor
