Safety & Environmental Management

Chemical Hygiene Plan

Revised: April, 2000

Appendix E - INCIDENT REPORTS


Natural and Applied Science and Human Biology policy requires an Incident Report Form to be filled out for the following occurrences:

  1. Significant personal injuries, such as those incurred because of cuts, burns, electric shock, etc. Report any incident where first aid is involved with the exception of minor cuts or burns. Any incident which requires treatment by an emergency responder or treatment at Health Services should be reported.
  2. Fires that require use of fire extinguisher.
  3. Mercury spills other than breakage of standard mercury thermometer.
  4. Concentrated (> 6 N) acid and base spills exceeding 100 mL.
  5. All spills of flammable chemicals exceeding 100 mL.
  6. All spills of toxic chemicals exceeding 100 mL. If TLV < 50 ppm, report spills exceeding 10 mL.
  7. Large water spills including use of safety showers and eye wash fountains.
  8. Exposure incidents involving blood or other potentially infectious materials.
  9. Any spill where a chemical is accidentally released into the sewer system or where a chemical is spilled onto ground outside.
INCIDENT REPORT FORM

Date of incident:
Personnel Involved (include student names):

 

Location:
Description of incident:

 

Description of response/treatment:

 

Cause of incident (if known):

 

Name of person submitting Incident Report:
Signature: Date:
Send completed report to a Chemical Hygiene Officer.