Fecal Incident Report Form
Use this form to report fecal contamination, cleanup needs, and related incident details accurately.
Incident Details
Incident Date
*
 -
Month
 -
Day
Year
Date
Incident Time
*
Hour Minutes
AM
PM
AM/PM Option
Exact Location/Area of Incident
*
Incident Type/Category
*
Human Waste
Animal Waste
Unknown Source
Sewage Backup
Contaminated Restroom
Contaminated Surface
Other
Brief Incident Description
*
Exposure, Impact, and Conditions
Areas/Items Affected
*
Floor
Restroom
Equipment
Clothing
Bedding
Food-Contact Surface
Outdoor Area
Other
Estimated Severity/Extent
*
Minor
Moderate
Major
Unknown
Anyone Exposed or Directly Involved?
*
Yes
No
Number of Affected Persons
Visible Condition at Discovery
*
Please Select
Fresh
Dried
Odor Present
Smeared
Contained
Overflow
Unknown
Immediate Health or Safety Concerns Observed
Response and Cleanup Actions
Actions Already Taken
*
Isolated area
Notified supervisor
Started cleanup
Disinfected area
Disposed of contaminated materials
Called maintenance
Contacted biohazard/cleanup team
Other
Time Response Began
*
Hour Minutes
AM
PM
AM/PM Option
Was the Area Closed Off?
*
Yes
No
Current Status of Incident
*
Please Select
Open
Contained
Cleaned
Awaiting inspection
Resolved
Follow-up or Additional Action Needed
Reporter Information
Reporter Name
*
First Name
Last Name
Role or Department
*
Contact Phone or Email
*
Additional Notes
Submit Report
Should be Empty: