Radiation Spill Incident Report
Date of Incident
Time of Incident
Location of Incident
Radiation Isotope(s) Involved
Activity (in mCi/Bq)
Quantity Spilled
Persons Involved
Description of Incident
Immediate Actions Taken
Assessment of Spread/Contamination
Decontamination and Cleanup Measures
Notifications Made (Name/Time)
Reported By (Name & Signature)
Date of Report