AMMONIA RELEASE REPORTING GUIDELINES - Salinas Valley ...

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FORM: EPR-2 EMERGENCY RESPONSE CHECKLIST Location of Leak: Date: Time of Day leak noticed: Time of day for end of incident: WEATHER CONDITIONS PRESENT DURING INCIDENT Temperature: Wind Direction: Speed: Humidity Fog? Rainy? Cloudy? Clear? 1. Is everyone accounted for? 2. Fire Department name and phone number – HazMat to dispatch from “911” a) Did you call the Fire Dept. for help? Y / N What time was the call ? 3. Do you need police for traffic control? Y / N What time was the call ? 4. Are there any injured ? Y / N How many ? 5. Do the injured need more than on site first aid ? Y / N 6. How did you transport them? Ambulance or Co-worker : 7. Time of Transportation : _______________________ Destination: 8. OSHA will need to be notified of any employee injury. Time of Call: 9. Name of OSHA individual who took your call: 10. Where any rooms (on-site) evacuated due to ammonia leak? (If Yes, complete below) Name of _____County Health Department person(s) who authorized re-entry: Date and Time of authorized re-entry: WHAT HAPPENED? (Standard Form used with permission of WPS) DISCLAIMER: This form is intended to serve as a reference for facility personnel in their development of facility reporting policy
Important Contacts: Specialists and hotline service here are a number of information specialists and hotline services available to provide information on hazardous substances. Examples include: • National Response Center (U.S. Coast Guard). This 24-hour service can give information on all aspects of release management. The law requires that employers notify the NRC for many releases. The telephone number is 800-424-8802. • Agency for Toxic Substances Disease Registry (ATSDR). This 24-hourservice will assemble an expert team of toxicologists and response experts and will come on site if needed. The telephone number is 888-422-8737. • CHEM-TEL Inc. - This 24-hour service will provide information on products as provided in manufacturers' MSDSs. The telephone number is 800-255-3924. • CHEMTREC - This 24-hour service will provide information on products as provided in manufacturers' MSDSs. It can assist in identifying and contacting a manufacturer of a product or shipment. The telephone number is 800-424-9300 or 703-527-3887. • National Pesticide Information Center. This 9:30 a.m. to 7:30 p.m. Eastern Time service will provide information on pesticides. The telephone number is 800-858-7378. • Rapid Response Information System (RRIS). This 24-hour service can be used as a reference guide, training aid, and an overall planning and training resource for response to a chemical, biological, and/or nuclear terrorist incident. • Regional Poison Control Centers (state-wide resources). This 24-hour service can provide information on the health risks associated with chemicals. It may have information on other hazards and appropriate responses. See the local telephone book for telephone numbers. • Manufacturer, importer, or distributor. The manufacturer, importer, or distributor of a hazardous substance may have a 24-hour hotline. Look for this telephone number on the MSDS or label. • Local Police, Fire, Medical, Hazmat, and Coast Guard 911 • Monterey County CUPA 831-755-4511 • California OES 1-800-862-7550 • Cal OSHA (24 hour) 1-916-263-2800
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AMMONIA RELEASE REPORTING GUIDELINES - Salinas Valley ...

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