Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-6282

2. Registrant Information.

Registrant Reference Number: URN

Registrant Name (Full Legal Name no abbreviations): SECURE ENERGY (Drilling Services) Inc.

Address: 3600, 205 - 5th Avenue SW

City: Calgary

Prov / State: Alberta

Country: Canada

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

Packaging Failure

4. Date registrant was first informed of the incident.


5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.


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.


PMRA Registration No. 33006      PMRA Submission No.       EPA Registration No.

Product Name: SECURE BIO-32C

  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


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?


Subform VI: Packaging Failure

1. What is the type of packaging that failed?

Other / Autre

specify Bulk tank

2. Did packaging failure occur during?


3. Did packaging failure result in?

potential exposure

4. Describe how the packaging failed and the surrounding circumstances, including a description of the potential injury or exposure.

Over-filled bulk tank due to issue with the site glass and inability to to properly see tank level. Approximately 10L spilled onto snow covered ground below. Spill was noticed and cleaned quickly. Any environmental exposure would be considered extremely negligible.

For Registrant use only

5. Provide supplemental information here.