Laboratory Chemical Spill Incident Report

Date of Incident Time of Incident Location (Building/Room)

Person(s) Involved Contact Information

Chemical(s) Spilled (Name & Quantity)

Description of Incident

Immediate Actions Taken

Was Anyone Exposed or Injured? No Yes If Yes, Provide Details

Spill Clean-up Method

Waste Disposal Method

Reported To (Supervisor/Safety Officer) Date & Time Reported

Additional Comments/Notes