Biological Spillage Incident Report
Date of Incident
Time of Incident
Location of Incident
Reported By
Contact Information
Biological Material Involved
Approximate Volume/Quantity Spilled
Description of the Incident
Suspected Cause
Was anyone exposed?
Yes
No
Immediate Action Taken
Personal Protective Equipment Used
Further Action Required/Recommended
Names of People Involved
Supervisor Notified
Signature
Date Submitted