Hazardous Material Exposure Report
Employee Information
Name
Employee ID
Department
Date of Exposure
Time of Exposure
Location
Incident Details
Hazardous Material Involved
Route of Exposure
Inhalation
Skin Contact
Ingestion
Eye Contact
Other
Description of Incident
Immediate Action Taken
Describe Actions Taken
Medical Attention
Was medical attention sought?
Yes
No
If yes, provide details
Supervisor
Supervisor Name
Report Date