Mercury Spill Incident Report Form
Date of Incident
Time of Incident
Location of Spill
Reported By
Contact Number
Department/Area
Description of Incident
Estimated Amount of Mercury Spilled
Immediate Actions Taken
People Exposed (if any)
Was Area Evacuated?
Yes
No
Spill Clean-up Team Notified?
Yes
No
Additional Notes
Name of Person Completing Report
Date Completed