Emergency Cleaning Checklist Form
Document and track emergency cleanup tasks following a spill, leak, or urgent mess.
Date and Time of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Incident
*
Type of Emergency
*
Please Select
Spill
Leak
Breakage
Other
Reported By (Full Name)
*
First Name
Last Name
Checklist of Emergency Cleaning Tasks
*
Isolate and secure the affected area
Wear appropriate personal protective equipment (PPE)
Contain and absorb the spill or leak
Clean and disinfect the area
Dispose of waste materials properly
Remove and dispose of PPE
Was additional help required?
*
Yes
No
Describe any remaining hazards or issues
Additional Notes or Comments
Submit Checklist
Should be Empty: