Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-7052

2. Registrant Information.

Registrant Reference Number: MRR-0117

Registrant Name (Full Legal Name no abbreviations): Baker Hughes Canada Company

Address: Gulf Canada Square, 1000-401 9th Ave. SW

City: Calgary

Prov / State: Alberta

Country: Canada

Postal Code: T2P 3C5

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

Human

4. Date registrant was first informed of the incident.

06-JUL-16

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

06-JUL-16

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. 27928      PMRA Submission No.       EPA Registration No. 10707-10

Product Name: MAGNACIDE B MICROBIOCIDE

• Active Ingredient(s)
  • ACROLEIN

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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.

Data Subject

2. Demographic information of data subject

Sex: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Eye
  • Symptom - Irritated eye

• Respiratory System
  • Symptom - Irritated nose

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)

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.

Eye

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.)

An employee reported he had been exposed to acrolein vapors while the nitrogen pressure within a skid of MAGNACIDE B MICROBIOCIDE was being released into a pail of soda ash and water solution for proper neutralization of any residual acrolein. When the employee approached the immediate area in the warehouse, his eyes and nose became irritated and he immediately evacuated from the warehouse to fresh air outside the building. Once in the fresh air, his symptoms quickly dissipated. The employee's condition was monitored repeatedly post-incident for any potential delayed health effects. No post-incident health effects or concerns were observed.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.