Schedule C-PEAS Incident Report.pdf
PDF 376 KB Posted
- Attached to
- RFP for PEAS Answering Services
- Solicitation number
- RFP 761 240000002261 2
- Issued by
- Michigan
About this file
This is an incident report form used by Michigan's Department of Environment, Great Lakes, and Energy (EGLE) Pollution Emergency Alerting System (PEAS) to document environmental incidents involving potential releases of hazardous materials. The form serves as the primary documentation tool for state and local environmental response coordination across Michigan jurisdictions.
The form captures comprehensive incident data including dispatch information, caller details, potentially liable party information, material released, environmental media impacted (water, ground, air), cleanup contractor assignments, and incident location coordinates. It documents the date, time, and nature of the incident; identifies responsible divisions and assigned staff; tracks referrals to related incidents; and records cleanup efforts and assistance requested. The form designates a lead division responsible for coordinating the response and distinguishes between private caller information (protected under FOIA exemptions) and public information that may be released through Freedom of Information Act requests. It requires documentation of incident occurrence versus observation timing, shift information, district assignment, cross streets, and water bodies impacted to facilitate rapid emergency response and environmental protection measures.
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Other files
| File | Type | Posted |
|---|---|---|
| RFP 24-2261 PEAS Answering Services Q & A.xlsx | XLSX spreadsheet | |
| RFP 240000002261 PEAS Answering Services.docx | DOCX document |
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Text version
Dispatch:
N
Special
Referral:
Lead Div. 1:
Division /
Affiliation
E-Mail Date / Time
Sent Fi le d B y
A ss ig n ed
To
Dispatch Date / Time End Hours
** Information in this form, except private callers' personal information (italics), is available from PEAS through FOIA.
PLP - Type:
Referral Notes
Release/Incident Controlled?:
Amount Released to Water:
Amount Released to Ground:
Amount Released to Air:
Cleanup Contractor:
Lead Div. 2:
Lead Staff Person(s)
Assigned:
Material Released:
W
Time Stamp: * PLP - Potentially Liable/Responsible Party
Date / Time Start Sensitive Information in Addition to Above any Private Caller Personal information Above (in italics)
Additional Notes
E-Mail Date / Time
Received
Phone Call or Page
Date / Time
Referrals
Water Body Impacted:
Referral Contact /
District
Related Incident Number(s):
PEAS Caller Phone 1:
PEAS Caller Name :
PEAS Caller Employer Name:
PEAS Caller Street Address:
PEAS Caller City or Twp., State:
PLP* - Personal Contact Name:
PLP - Street Address:
PLP - Phone 1:
State PLP - City or Twp.
Michigan EGLE PEAS Incident Report
PLP - Employer Name:
Incident Lat./Long.:
Incident County:
Date & Time of Call:
Incident Occurred:
Incident Observed:
Shift:
District:
Description of Incident (incl. cleanup efforts, assistance requested, etc.):
PEAS Caller Phone 2:
Incident Street Address:
Incident City or Twp.:
PEAS Incident Number:
Incident Cross Streets:
PEAS Caller Type:
PLP - Phone 2:
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