Mercury Spill Response Documentation

Date and Time of Spill Location Person Reporting Spill Contact Information

Spill Details

Estimated Quantity of Mercury Spilled Description of How Spill Occurred

Response Actions

Initial Actions Taken Personnel Involved in Cleanup Description of Cleanup Procedure Personal Protective Equipment Used Materials and Equipment Used

Disposal Details

Mercury Waste Disposal Method Disposal Date

Follow-Up

Area Decontaminated Post-Cleanup Air Monitoring Results Additional Notes / Comments

Sign-Off

Name	Signature	Date