Attachment D Spill Response Form.pdf
PDF 1 MB Posted
- Solicitation number
- W9127N24Q0014
About this file
The attached document is a spill response form template to be completed in the event of an environmental spill. It requests details of the reporting party, spill location, material and quantity spilled, environmental impacts, and tracking numbers for notifying response agencies. An incident action plan section lists strategic goals and tactical objectives for performing hazard assessment, establishing site security and command, evacuating injuries, containing and controlling the spill, and initiating cleanup.
The related federal contract opportunity is solicitation number W9127N24Q0014 from the U.S. Army Corps of Engineers Portland District for inspections and maintenance of PATON stern mooring buoys. Services required include inspection and maintenance of physical aids to navigation. The solicitation posting indicates the opportunity type and issuing agency but provides no further salient details regarding response dates, pricing terms, set asides, incumbents or other contract requirements.
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Text version
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
ATTACHMEND D - PAGE 1
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