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Tulane University Health Sciences Center
OEHS
Hazardous Materials Incident Form

PLEASE NOTE THAT THE SUPERVISOR INVOLVED WITH THE INCIDENT MUST COMPLETE THIS REPORT WITHIN 48 HOURS OF THE OCCURRENCE AND SUBMIT IT TO ENVIRONMENTAL HEALTH AND SAFETY

Steps to submit the hazardous materials incident form:
1. Fill in all applicable boxes
2. Use the mouse to make a selection.
3. DO NOT HIT RETURN OR THE FORM WILL BE SENT.
4. Click the 'Submit Query' button when finished
5. The form is automatically e-mailed to Bruce McClue when you submit it.

Building:
Room/Location: 
Date of Incident: 
Time: 
Type of Material:
    Radioactive:
    1. Yes
    2. No
    Chemical:
    1. Yes
    2. No
 Type of Material:
    Mercury:
    1. Yes
    2. No
    Infectious:
    1. Yes
    2. No
 Type of Material:
    Chemotherapeutic Agent:
    1. Yes
    2. No
    Other:
Name of Agent Spilled:
Size of Spill (by amount spilled or square footage):
Briefly Explain How the Spill Occurred
Briefly Explain How the Spill was Cleaned Up
Briefly Explain Preventative Measures
Were Personal Protective Devices Used By Employees During the Spill Clean Up?
  1. Yes
  2. No
List Items:
Was Environmental Health and Safety Contacted At the Time of the Spill?
  1. Yes
  2. No
Department: Date:
Phone Number: 
Supervisor Completing this Report:

When you are finished filling out the form, click on the Submit Query
button to send the form!!

 

 
 

Office of Environmental Health and Safety
Copyright 1997 - 2003

Web page is maintained by:
Karen Simon
e-mail me with comments


Tulane University
Office of Environmental Health and Safety (OEHS)
1430 Tulane Avenue, TW16 (Mailing Address)
1440 Canal Street, Suite 1156 (Physical Address)
New Orleans, LA 70112 -2699
(504) 988-5486 telephone
(504) 988-1693 fax