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