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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2024-4542
2. Registrant Information.
Registrant Reference Number: 332760
Registrant Name (Full Legal Name no abbreviations): Premier Tech Ltd.
Address: 1 avenue Premier
City: Riviere-du-Loup
Prov / State: Quebec
Country: Canada
Postal Code: G5R 6C1
3. Select the appropriate subform(s) for the incident.
Packaging Failure
4. Date registrant was first informed of the incident.
19-JUN-245. Location of incident.
Country: CANADA
Prov / State: SASKATCHEWAN
6. Date incident was first observed.
Unknown
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. 27901 PMRA Submission No. EPA Registration No.
Product Name: Wilson Ant Out Ant Killer
- Active Ingredient(s)
- PERMETHRIN
7. b) Type of formulation.
Application Information
8. Product was applied?
Unknown
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 VI: Packaging Failure
1. What is the type of packaging that failed?
Bottle-plastic / Bouteille-plastique
2. Did packaging failure occur during?
Use of Product
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.
Customer has experienced issues with the sprayer nozzle and trigger. Customer tightened the head as thought it could be loose, however it still leaked. It has leaked all over their hands when applying in rapid succession the trigger.
