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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-0006

2. Registrant Information.

Registrant Reference Number: NU-CA-20122017

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

Address: 2168 Hopewell Place NE, Suite 350

City: Calgary

Prov / State: Alberta

Country: Canada

Postal Code: T1Y 7J7

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

Human

4. Date registrant was first informed of the incident.

29-DEC-17

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

20-DEC-17

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. 29888      PMRA Submission No.       EPA Registration No.

Product Name: Credit Xtreme Herbicide

  • Active Ingredient(s)
    • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE AND POTASSIUM SALT)

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: Male

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

3. List all symptoms, using the selections below.

System

  • Skin
    • Symptom - Other
    • Specify - No symptoms were observed

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)

Pesticide Spill

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

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.

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.)

The length of exposure was 1 minute. As soon as the Credit Xtreme herbicide spilled on the persons shoes, immediately he removed the socks and shoes, and washed his feet thoroughly with clean water, and changed into new socks and shoe.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

The person was asymptomatic on the day of incident. He showed no symptoms as of today i.e., January 2, 2018.