Mining Operation Chemical Spill Documentation

General Information

Date of Incident Time of Incident Location Reported By

Chemical Information

Chemical Name Approximate Quantity Spilled Physical State Liquid Gas Solid Hazard Classification

Spill Details

Description of Incident Suspected Cause

Environmental & Health Impact

Area Affected Observed Health Effects Observed Environmental Impact

Response Actions

Containment Measures Cleanup Procedures Personnel Involved

Follow-up & Reporting

Further Actions Required Agencies Notified Additional Notes / Remarks