Fire or Explosion Laboratory Report Form
General Information
Date of Incident
Time of Incident
Location (Building/Lab Room)
Reported By
Incident Details
Type of Incident
Fire
Explosion
Other
Description of Incident
Suspected Cause
Response
Actions Taken
Evacuation Required?
Yes
No
Emergency Services Contacted?
Yes
No
Injuries and Damage
Injuries (Names, Nature of Injuries)
Damage to Property/Equipment
Follow-up Actions
Proposed Follow-up Actions/Recommendations
Reviewed By
Name
Date