Laboratory Chemical Spill Incident Report
1. Incident Details
Date of Incident
Time of Incident
Location (Building/Lab Room No.)
Reported By
Contact Information
Supervisor/PI Notified
2. Chemical(s) Involved
Name of Chemical(s)
Amount Spilled (approx.)
Hazard Classification (if known)
3. Description of Incident
Describe How the Spill Occurred
Area Contaminated (describe affected surfaces/objects)
4. Injury/Exposure
Was anyone injured or exposed to the chemical?
No
Yes
If yes, describe the nature and extent of injury/exposure
5. Response & Cleanup
Immediate Actions Taken
Personal Protective Equipment Used
Describe Cleanup Method
Disposal of Contaminated Materials
6. Follow-up
Corrective/Preventive Action(s) Taken or Recommended
Additional Comments