Title Page

  • Site

  • Conducted on

  • Prepared by

  • Location

HAZMAT Incident Checklist

Incident Information

  • Incident Name

  • Start Time

  • Comp. Time

Weather Information

  • Present:

  • Time

  • Wind Direction

  • Wind Speed

  • Rain/Snow

  • Temp. (°F)

  • 1-Hour Forecast:

  • Time

  • Wind Direction

  • Wind Speed

  • Rain/Snow

  • Temp. (°F)

  • Long Term Forecast:

  • Time

  • Wind Direction

  • Wind Speed

  • Rain/Snow

  • Temp. (°F)

  • Resource Information
  • Name

  • Assignment

Checklist

  • Hot Zone

  • Warm Zone

  • Cold Zone

  • Evacuation

  • Diking

  • Diversion

  • Retention

  • Special Equip. Needed

  • Decon

  • Medical

  • Rehabilitation

  • Research

  • Product Identification

  • PPE

  • Resource

  • Mutual Aid

  • Chemical Cleanup

  • Safety Briefing

  • Post Critique

Agencies Contacted

  • Law Enforecement

  • Health Department

  • ChemTrec

  • EPA

  • ADEQ

  • Other

  • Identify Other

Termination Activities

  • Decontamination

  • Rehabilitation

  • Site Clean-up

  • Medical Screening

  • Exposure Reporting

  • Incident Debriefing

Completion

  • Notes

  • Conducted by: Name and Signature

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