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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2020-1976
2. Registrant Information.
Registrant Reference Number: x
Registrant Name (Full Legal Name no abbreviations): x
Address: x
City: x
Prov / State: x
Country: x
Postal Code: X
3. Select the appropriate subform(s) for the incident.
Human
Environment
4. Date registrant was first informed of the incident.
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
18-JUN-20Product 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.
Product Name: Finalsan Pro
- Active Ingredient(s)
- AMMONIUM SALT OF FATTY ACID
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
Unknown
10. Site pesticide was applied to (select all that apply).
Site: Res. - Out Home / Rés - à l'ext.maison
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
At around 1:40 p.m. on Thursday June 18th I saw a (company) technician coming down our long driveway (address) broadcast spraying from a hose (that my wife and I later saw was attached to his truck). Please note we share a long driveway with (address). I called out to tell him to stop spraying as he was spraying on our property. At this point my wife (name) could see the tech spraying also. The tech informed us he had instructions to spray the driveway. The tech told us he had been spraying 15 feet from the bottom of our stairs, on our property. The contract for (company) was in fact with the neighbours at (address). The tech quickly rolled up the hose and left, without leaving a notice to show what he had sprayed on our property. The tech wasn't wearing any PPE, immediately left and provided no information about the spraying. My wife called (name) at the (company) office at 1:44 and again at 2 12 on Thursday June 19th asking what was sprayed. She was unable to provide that information. No notice had been posted. (name) called my wife at 2:50 on Thursday to tell her that the product sprayed was FinalSan. When my wife again asked what their company protocol was for unauthorized spraying, she said she didn't know. My wife called (company) office on Friday June 19th, and spoke with (name), a co-owner who informed my wife the product sprayed was Finalson Pro. (name) agreed to send product information (which came in an email hours later). In an e-mail on Friday, June 19th (name) admitted that there had been a mistake and our yard had been sprayed.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
- Specify - tingling
- Nervous and Muscular Systems
- Symptom - Dizziness
- Symptom - Recumbent
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?
Unknown
7. Exposure scenario
Non-occupational
8. How did exposure occur? (Select all that apply)
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.
Unknown
11. What was the length of exposure?
Unknown / Inconnu
12. Time between exposure and onset of symptoms.
>2 hrs <=8 hrs / > 2 h < = 8 h
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 following was reported: The tech who sprayed did not inform us of the extent to which he had sprayed and consequently we were unknowingly walking through this area minutes after spraying. Our windows were open and you could and can still smell a strong odour in our yard and inside our house (now 39 hours later). My wife felt nauseous from about Thursday at 2:00 p.m. until noon on Friday. Both my wife and I had stinging eyes on Thursday evening. I was dizzy upon waking up and unable to get out of bed for two hours.
To be determined by Registrant
14. Severity classification.
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: Female
Age: Unknown / Inconnu
3. List all symptoms, using the selections below.
System
- Gastrointestinal System
- Symptom - Nausea
- Eye
- Symptom - Irritated eye
- Specify - tingling
4. How long did the symptoms last?
>8 hrs <=24 hrs / > 8 h < = 24 h
5. Was medical treatment provided? Provide details in question 13.
Unknown
6. a) Was the person hospitalized?
Unknown
6. b) For how long?
Unknown
7. Exposure scenario
Non-occupational
8. How did exposure occur? (Select all that apply)
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.
Unknown
11. What was the length of exposure?
Unknown / Inconnu
12. Time between exposure and onset of symptoms.
<=30 min / <=30 min
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 following was reported: The tech who sprayed did not inform us of the extent to which he had sprayed and consequently we were unknowingly walking through this area minutes after spraying. Our windows were open and you could and can still smell a strong odour in our yard and inside our house (now 39 hours later). My wife felt nauseous from about Thursday at 2:00 p.m. until noon on Friday. Both my wife and I had stinging eyes on Thursday evening. I was dizzy upon waking up and unable to get out of bed for two hours.
To be determined by Registrant
14. Severity classification.
15. Provide supplemental information here.
Subform IV: Environment (includes plants insects and wildlife)
1. Type of organism affected
Herbaceous Plants / Plante herbacée
2. Common name(s)
Clover
3. Scientific name(s)
4. Number of organisms affected
100
5. Description of site where incident was observed
Fresh water
Terrestrial
Residential
Salt Water
6. Check all symptoms that apply
Death
7. Describe symptoms and outcome (died, recovered, etc.).
The following was reported: By about 5:00 p.m. on Thursday we observed that all the clover we had as lawn around 1.5 sides of our house and around our vegetable gardens was dead/dying. From the damage we estimate this company sprayed 73 feet of our property (east/west) and in one place 26 feet deep (to the north).
8. a) Was the incident a result of (select all that apply)
Application
8. b) i) How many times has the product been applied this year?
Unknown
8. b) ii) What was the date of the last application?
Unknown
9. Did it rain
9. a) During application?
Unknown
9. b) Up to 3 days after application?
Unknown
10. a) Was there a buffer zone?
Unknown
10. b) What type?
Terrestrial
10. c) What was the size of the buffer zone?
11. a) Were environmental samples collected and analysed?
No
