Incident Report • CampusOptics

University of Texas at Tyler ~ 3900 University Blvd. ~ EH&S (903)-566-7011

Reporter Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Campus, Building, or Outdoor Area* Required

Additional Location Details

Exact Location

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What were the events that led up to the occurrence of this spill?

Date spill occurred or was discovered

Material spilled

Amount spilled

Approximate area covered by spill

Any personnel contaminated? Describe and include any first aid provided

Any soil or water contaminated? Describe:

Describe how the spill occurred (to the best of your knowledge.) Include any relevant circumstance in as much detail as possible.

What containment measures were taken to control the spill?

What corrective actions were taken to control and clean up the spill?

List any existing or potential hazards that either caused or resulted from the incident.

What was done with the cleanup materials?

Was it a hazardous waste? Check with Environmental Health and Safety (EHS) if unsure. (903) 566-7011

Add files to upload as supporting documentation along with your incident.