AFP-JSC-EXP-2026 - Attachment F - JSC Flash Report Template 1.pdf
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- Attached to
- AFP for Exploration Park at JSC
- Solicitation number
- AFP-JSC-EXP-2026
About this file
This is a JSC Spill Flash Report template used for documenting hazardous material incidents at Johnson Space Center (JSC) facilities. The form captures critical incident information including location details (building, room, directional orientation), date and time of the incident, and notification/response start times. It provides checkboxes for classifying the type of incident: personnel injury, fire, sanitary sewer overflow, gaseous emission, asbestos spill, hazardous material spill, or other incidents.
The template requires documentation of incident descriptions, extent of injuries or environmental damage, and corrective actions divided into immediate and follow-on responses. It includes sections for identifying whether emergency dispatch and response teams were notified, listing witnesses, and recording NASA and contractor personnel notifications. The form also captures details about the substance spilled or released and its quantity, whether soil or storm water were affected, and whether the reportable quantity (RQ) was exceeded. Additional required information includes whether a follow-up written report is needed, if regulatory agency notification is required (with specific contact details, date of notice, and reporting method), and whether environmental samples were collected with results attached. The template provides space for preparer and reporter identification with organization and contact information.
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Text version
JSC SPILL FLASH REPORT
LOCATION/DATE/TIME:
Building: Room: Other: N S E W Date Of Incident (M/D/YY): Time of Notification: AM PM
Time of Spill Response Start: AM PM
TYPE OF INCIDENT:
Personnel Injury Asbestos Spill Fire Hazardous Material Spill Sanitary Sewer Overflow Other:
Gaseous Emission (e.g., natural gas)
DESCRIPTION OF INCIDENT:
EXTENT Of INJURIES, PROPERTY DAMAGE, or ENVIRONMENTAL DAMAGE (If Applicable):
CORRECTIVE ACTION TAKEN:
Immediate Actions:
Follow-on Actions:
Emergency Dispatch Center Called? Yes No Emergency Response Team Called? Yes No Witnesses:
NASA and/or Contractor Personnel Notified:
Prepared By:
Organization: Telephone:
cell:
Reported By: Organization: Telephone:
Substance Spilled/Released: Amount of Spill/Release:
Substance Affected Soil? Yes No Substance Reached Storm Water? Yes No Reportable Quantity (RQ) for Released Substance: RQ Exceeded? Yes No Follow-Up Written Report Required: Yes No If yes, date due:
Additional Action Required: Yes No Describe:
Notice to Regulatory Agency Required: Yes No If yes, complete the following:
Agency Contacted:
Name and Phone of Contact:
Date of Notice:
Means of contact (e.g., phone call, fax):
Name of Person who Reported to Agency:
Sample Collected: Yes No Attach copy of map showing sampling location and copy of results
Sample Results: Further action required based on sample results? Yes No Describe:
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