Use this report for all Non-Accident Releases (NAR’s) and Accident Caused Releases. Car Number: Conduct a job specific safety briefing, know your protection and know your product. (ex: UTLX 1234) Return to HazMat Manager that initiated you within 3 days EVENT INFORMATION: Date Time Notified: CT MT PT Arrival Time of Arrival CT MT PT Notified: (Use 24 Hr. Time) Date: (Use 24 Hr. Time) Address of City: State: Incident: Train Yard/Hub Track/ County: Address: Lot No: Mainline Mainline Milepost/ Name of person First City: County: GPS: Contacted on Scene: Proper Shipping Name Hazardous UN No. of Product: Class/Division: GENERAL INFORMATION: Built Date: Identification Markings: PRD PRD Month/Year (ex: DOT111A100W1, 1M 101) Rating: Type: Last Inspection Next Inspection Found Replaced Date: Date: Seal No.: Seal No.: Transportation In Transit Loading Unloading In Transit Storage AAR Cause Code: Phase: INITIAL FINDINGS: Estimated Product Lost: Gal. Lbs. Show location of Leak(s) and/or damage on diagrams below: CAR ORIENTATION: ROOT CAUSE/OTHER OBSERVATIONS: ACTIONS TAKEN DISPOSITION OF CAR: (if known) (example: repaired and continuing in transit) COST ESTIMATE: (This is an estimate only) Estimated Response Cost: $ Estimated Remediation Cost: $ PHOTOS (must be taken of the following items) Equip. Profile All Sides Qualification Stencil Build Date What is Leaking Seals (Shipper & Replacement) Completed Repairs Equipment Profile All Sides - Required Side 1 Side 2
Use this report for all Non-Accident Releases (NAR’s) and Accident Caused Releases. Conduct a job specific safety briefing, know your protection and know your product. Return to HazMat Manager that initiated you within 3 days Car Number: (ex: UTLX 1234) EVENT INFORMATION: Date Notified: Time Notified: (Use 24 Hr. Time) CT MT PT Arrival Date: Time of Arrival (Use 24 Hr. Time) CT MT PT Address of Incident: City: State: County: Train Yard/Hub Address: Track/ Lot No: Mainline City: Mainline County: Milepost/ GPS: Name of person First Contacted on Scene: Proper Shipping Name of Product: Hazardous Class/Division: UN No. GENERAL INFORMATION: Built Date: Month/Year Identification Markings: (ex: DOT111A100W1, 1M 101) PRD Rating: PRD Type: Last Inspection Date: Next Inspection Date: Found Seal No.: Replaced Seal No.: Transportation Phase: In Transit Loading Unloading In Transit Storage AAR Cause Code: INITIAL FINDINGS: Estimated Product Lost: Gal. Lbs. Show location of Leak(s) and/or damage on diagrams below: CAR ORIENTATION: ROOT CAUSE/OTHER OBSERVATIONS: ACTIONS TAKEN DISPOSITION OF CAR: (if known) (example: repaired and continuing in transit) COST ESTIMATE: (This is an estimate only) Estimated Response Cost: $ Estimated Remediation Cost: $ PHOTOS (must be taken of the following items) Equip. Profile All Sides Qualification Stencil Build Date What is Leaking Seals (Shipper & Replacement) Completed Repairs Equipment Profile All Sides - Required Side 1 Side 2
Hazmat-Response-Incident-Report.docx