HEALTH, SAFETY & Doc.

No: GMS-HSE-FRM-10
ENVIRONMENTAL MANAGEMENT
Revision: 0
SYSTEM – FORMS

CHEMICAL & OIL SPILL REPORT

TO:
1 PLACE AND TIME: Accurate Time of Spill:

Location: Comments:

Department:
Project:

2 CAUSE OF SPILL: TYPE OF SPILL:

Source of Spill: Type of Oil:
Description:

3 HAZARDS: PREVENTIVE HAZARDOUS ACTION:

Hazards: Yes  No  Description of preventive action, if any:
Type of Hazards, If any:

4 DESCRIPTION OF SPILL: Samples taken: Yes  No 

Present slick position: Lat: Description:

Long:
Present dimensions of slick:
Velocity of drift:
Slick direction:

5 CLEARANCE OPERATION:
Dispersant in use: Yes  No  If yes, description:

Details of spill clearance operations and progress:

6 REPORTING:
Will there be need for further reporting: Yes  If yes: Regulatory Authorities  Client 

If yes, has this been sent: Yes  No 

Comments:

7 ADDITIONAL COMMENTS:

9 SIGNATURES:
Date: Manager: Date: Observer:
The report will be submitted to the HSE Department not more than 8 hours of any occurrence of environmental pollution.