Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2024-2393

2. Registrant Information.

Registrant Reference Number: 2024-06-06 Thermopro Nadjib

Registrant Name (Full Legal Name no abbreviations): Solesco Inc.

Address: 2405 rue de Celles, unite 5

City: Quebec

Prov / State: Quebec

Country: Canada

Postal Code: G2C 1K7

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

Human

4. Date registrant was first informed of the incident.

06-JUN-24

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

05-JUN-24

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. 32790      PMRA Submission No.       EPA Registration No.

Product Name: Solubact IZ-15 Microbicide Liquide

• Active Ingredient(s)
  • CHLORO-5 METHYL-2 ISOTHIAZOLINE-4 ONE-3
  • METHYL-2 ISOTHIAZOLINE-4 ONE-3

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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: Industrial / Industriel

Préciser le type: Tour de refroidissement

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?

No

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

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Rash
  • Symptom - Erythema

• General
  • Symptom - Discomfort

• Skin
  • Symptom - Irritated skin

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?

No

6. b) For how long?

7. Exposure scenario

Occupational

8. How did exposure occur? (Select all that apply)

Application

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

Long pants

Goggles

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.

>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.)

La personne a consulte un chimiste, qui lui a recommande de consulter un medecin en conformite avec les recommandations de l'etiquette et de la fiche de donnees de securite, mais il n'est pas connu si la personne a suivi les recommandations.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Il est anticipe que l'erytheme se resorbe apres quelques jours. La superficie affectee est environ la surface d'une main sur le bras droit. Un inconfort est ressenti de l'irritation.