💧 Spill or Release Report

18 AAC 75.300 (ADEC notice); 33 USC 1321 / 40 CFR 110 (National Response Center for a sheen or discharge to water).

Audit information

Your name *

Date *

Location *

Date and time discovered

Substance released

Estimated volume (gallons)

Did it reach water?

Source and cause

Agencies notified, time, and report or case number

Immediate actions

Area made safe and people accounted for

Source stopped or controlled

Release contained

Supervisor and HSE notified

Notifications

ADEC notified within the required time

National Response Center notified if water was reached or a sheen was seen

Other agencies notified as required

Case or report numbers recorded

Cleanup

Cleanup started

Waste collected, labeled and stored for disposal

Follow-up report scheduled

Findings and corrective actions

Findings / comments

Corrective actions (who and by when)

Photos (take a picture or pick from your library or files, as many as you need)

Photos and PDFs, 15MB max each. Attachments lock when the form is submitted.

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