Chemical Exposure Medical Incident Log (Shipboard)
Date of Incident
Time of Incident
Location (Shipboard)
Name of Exposed Individual
Rank/Position
Department
Chemical(s) Involved
Route of Exposure
Inhalation
Skin Contact
Eye Contact
Ingestion
Other
Description of Incident
Symptoms Observed
First Aid/Medical Treatment Provided
Follow-up Actions/Recommendations
Witness(es)
Reported By
Date Reported