B.08 Attachment C Spill Response Form.pdf

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Attached to
Mooring Buoy Installation Service
Solicitation number
W9127N23Q0030
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SPILL EMERGENCY - INITIAL REPORT FORM

1. Reporting Name: _____________________ Responsible Party: ____________________

2. Location of Spill (include County, Nearest Town, County, Township, Range, Rivermile)

3. Spill Description (time & date spilled, material involved, quantity)

4. Environmental Impacts: Air? Surface Water? Groundwater? Fish? Wildlife?

5. Reporting Tracking No. Date/Time POC

National Response Center: ______________________________________________

Oregon Emergency Response System: ______________________________________________

Washington Emergency Management: ______________________________________________

6. Incident Action Plan: Strategic Goals (what to do) and Tactical Objectives (who & how)

Strategic Goals Tactical Objectives

a. Perform Hazard Assessment ____________________________________________

b. Establish Site Security ____________________________________________

c. Establish Incident Command ____________________________________________

d. Evacuate Injured or Exposed ____________________________________________

e. Contain the Spill ____________________________________________

f. Control the Spill ____________________________________________

g. Initiate Cleanup ____________________________________________

SPILL RESPONSE FORM

Attachment C - 1

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