Déclaration d'incident

Sous-formulaire I: Renseignements généraux

1.Type de rapport.

Nouvelle déclaration d'incident

No de la demande: 2013-2888

2. Renseignements concernant le titulaire.

Numéro de référence du titulaire d'homologation: x

Nom du titulaire (nom légal complet, aucune abbréviation): x

Adresse: x

Ville: x

État: x

Pays: x

Code postal /Zip: X

3.Choisir le (les) sous-formulaire(s) correspondant à l'incident.

Incident chez l'humain

4. Date à laquelle le titulaire d'homologation a été informé pour la première fois de l'incident.

5. Lieu de l'incident.

Pays: CANADA

État: ONTARIO

6. Date de la première observation de l'incident.

05-MAY-13

Description du produit

7. a) Donner le nom de la matière active et, si disponibles, le numéro d'homologation et le nom du produit (incluant tous les mélanges). Si le produit n'est pas homologué, donner le numéro de la demande d'homologation.

Matière(s) active(s)

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ARLA No d'homologation 28715      ARLA No de la demande d'homologation       EPA No d'homologation.

Nom du produit: PIC PLUS FUMIGANT

• Matière active
  • CHLOROPICRIN
    • Garantie/concentration 85 %

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7. b) Type de formulation.

Renseignments sur l'application

8. Est-ce que le produit a été appliqué?

Oui

9. Dose d'application.

Inconnu

10. Site d'application (choisir tout ce qui s'applique).

Site: Agricultural-Outdoor/Agricole-extérieur

Specify Type: tobacco - soil treatment prior to planting

11. Donner tout renseignement additionnel concernant l'application (comment le produit a été appliqué, la quantité utilisée, la superficie de la zone traitée, etc.)

The farmer was spreading Chloropicrin injected with nitrogen. The Sgt. indicates that the field is approximately 15 acres and the farmer applied the injection chemical yesterday. Explains that the family of 3 arrived at hospital, and medical staff alterted FD thinking that there was a gas leak. FD arrived on scene and determined the cause to be a pesticide sprayed on the farm. OPP reporting that there are no watercoureses nearby and the area is primarily farmland. There is nothing in close proximity to the land. SAC inquired about potential for drinking water impacts - no nearby DW sources, some private wells in the area. HU has been notified by OPP. Weather reported by OPP to be 8C with no wind. 43 acres treated with chloropicrin on this site. Started application 1pm Saturday on east side of this farm. On Sunday they did a 14 acre field across the road. Finished the west part of this farm yesterday (Tuesday). Appeared to be injecting about 8 inch deep.MOE observed field. Large root clods of rye plowdown crop are noticeable. Suspect root clods may have prevented consistent effective sealing of soil following injection of chloropicrin.

À être déterminé par le titulaire

12. Selon vous, le produit a-t-il été utilisé en conformité avec le mode d'emploi de L'étiquette?

Inconnu

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: Unknown / Inconnu

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Oeil
  • Symptôme - Irritation de l'oeil

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Non professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Dérive du pesticide à partir de la zone traitée

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Aucun

10. Voie(s) d'exposition.

Yeux

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

>2 hrs <=8 hrs / > 2 h < = 8 h

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

The incident forced a family of three out of their home at 3am. They went to hospital with eye irritant complaints. FD and police were dispached to the site at 2:59 when a family was taken to hospital with eye irritation. FD is now going door-to-door requesting residents to keep their windows closed. There is a shelter-in-place initiated, but no further evacuations. OPP relays that this happened 3 times last year, and compared to the others, this is quite minor in severity. There is a precautionary 1/2 mile shelter-in-place established. No other symptoms to any other residences found at this time. OPP are still working on notifying all residents (estimated 15 homes). With the warm weather, the tobacco transplants are getting ready to go, farmers feels rushed to get the fields fumigated after a late spring so that the plants can go in the ground, last year, treatments were spread over about 3 weeks, this year the same treatments havea occurred in about 10 days. One report indicates that the site was only evacuated for 1 1/2 hours - the homeowners work in the middle of the night and felt eye irritation, went to Tim Horton's for 1 1/2 hours while it cleared, then returned home. It was reported that irrigation after application was not a viable option for these farmers; The FD apparently felt it was a much less severe situation than last years incidents, they had taken the training from distributor, and thought it was very helpful in dealing with the situation; According to distributor the road was not closed and the residents were only out of their home for about 1 1/2 hours; when he attended the site on Sunday morning, he felt that there was adequate soil moisture, so he couldnt explain why the material had come out of the soil; distributor indicated that about 15,000 acres have been fumigated so far this year; he is encouraging farmers to wait for some rain if possible, and to inject deeper (6-8 inches) and mound the soil higher (the older machines can mound about 6", newer machines higher). At 4am Sunday morning Pic Plus could be smelled at farm, when the police woke the family up.

À être déterminé par le titulaire

14. Classification selon la gravité.

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: Unknown / Inconnu

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Oeil
  • Symptôme - Irritation de l'oeil

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Non professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Dérive du pesticide à partir de la zone traitée

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Aucun

10. Voie(s) d'exposition.

Yeux

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

>2 hrs <=8 hrs / > 2 h < = 8 h

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

The incident forced a family of three out of their home at 3am. They went to hospital with eye irritant complaints. FD and police were dispached to the site at 2:59 when a family was taken to hospital with eye irritation. FD is now going door-to-door requesting residents to keep their windows closed. There is a shelter-in-place initiated, but no further evacuations. OPP relays that this happened 3 times last year, and compared to the others, this is quite minor in severity. There is a precautionary 1/2 mile shelter-in-place established. No other symptoms to any other residences found at this time. OPP are still working on notifying all residents (estimated 15 homes). With the warm weather, the tobacco transplants are getting ready to go, farmers feels rushed to get the fields fumigated after a late spring so that the plants can go in the ground, last year, treatments were spread over about 3 weeks, this year the same treatments havea occurred in about 10 days. One report indicates that the site was only evacuated for 1 1/2 hours - the homeowners work in the middle of the night and felt eye irritation, went to Tim Horton's for 1 1/2 hours while it cleared, then returned home. It was reported that irrigation after application was not a viable option for these farmers; The FD apparently felt it was a much less severe situation than last years incidents, they had taken the training from distributor, and thought it was very helpful in dealing with the situation; According to distributor the road was not closed and the residents were only out of their home for about 1 1/2 hours; when he attended the site on Sunday morning, he felt that there was adequate soil moisture, so he couldnt explain why the material had come out of the soil; distributor indicated that about 15,000 acres have been fumigated so far this year; he is encouraging farmers to wait for some rain if possible, and to inject deeper (6-8 inches) and mound the soil higher (the older machines can mound about 6", newer machines higher). At 4am Sunday morning Pic Plus could be smelled at farm, when the police woke the family up.

À être déterminé par le titulaire

14. Classification selon la gravité.

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: Unknown / Inconnu

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Oeil
  • Symptôme - Irritation de l'oeil

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Non professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Dérive du pesticide à partir de la zone traitée

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Aucun

10. Voie(s) d'exposition.

Yeux

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

>2 hrs <=8 hrs / > 2 h < = 8 h

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

The incident forced a family of three out of their home at 3am. They went to hospital with eye irritant complaints. FD and police were dispached to the site at 2:59 when a family was taken to hospital with eye irritation. FD is now going door-to-door requesting residents to keep their windows closed. There is a shelter-in-place initiated, but no further evacuations. OPP relays that this happened 3 times last year, and compared to the others, this is quite minor in severity. There is a precautionary 1/2 mile shelter-in-place established. No other symptoms to any other residences found at this time. OPP are still working on notifying all residents (estimated 15 homes). With the warm weather, the tobacco transplants are getting ready to go, farmers feels rushed to get the fields fumigated after a late spring so that the plants can go in the ground, last year, treatments were spread over about 3 weeks, this year the same treatments havea occurred in about 10 days. One report indicates that the site was only evacuated for 1 1/2 hours - the homeowners work in the middle of the night and felt eye irritation, went to Tim Horton's for 1 1/2 hours while it cleared, then returned home. It was reported that irrigation after application was not a viable option for these farmers; The FD apparently felt it was a much less severe situation than last years incidents, they had taken the training from distributor, and thought it was very helpful in dealing with the situation; According to distributor the road was not closed and the residents were only out of their home for about 1 1/2 hours; when he attended the site on Sunday morning, he felt that there was adequate soil moisture, so he couldnt explain why the material had come out of the soil; distributor indicated that about 15,000 acres have been fumigated so far this year; he is encouraging farmers to wait for some rain if possible, and to inject deeper (6-8 inches) and mound the soil higher (the older machines can mound about 6", newer machines higher). At 4am Sunday morning Pic Plus could be smelled at farm, when the police woke the family up.

À être déterminé par le titulaire

14. Classification selon la gravité.

15. Donner des renseignements additionnels ici.