Hazardous Waste Exposure Incident Report
1. Incident Details
Date of Incident
Time of Incident
Location
2. Exposed Individual(s)
Name(s)
Job Title/Role
Contact Information
3. Hazardous Material Information
Type of Hazardous Waste
Chemical Name(s)/Description
Quantity Involved
4. Description of Incident
Describe What Happened
Route of Exposure (e.g., inhalation, skin contact)
Immediate Actions Taken
5. Medical Attention
Was Medical Assistance Provided?
Details of Medical Care (if applicable)
6. Witnesses
Name(s) of Witnesses
Contact Information
7. Reported By
Name
Date