Small-Scale Mercury Spill Record Sheet
Date of Spill:
Time of Spill:
Location:
Person Notifying:
Estimated Quantity of Mercury:
Description of Spill:
Immediate Actions Taken:
Personnel Involved:
PPE Used:
Cleanup Procedure:
Waste Disposal Method:
Area Ventilated:
Yes
No
Area Monitored Post Cleanup:
Yes
No
Reported to (authority/person):
Date/Time Reported:
Comments/Follow-up Actions:
Recorded by:
Date: