{"operation":"document","citation":"PHMSA Guidance, Guide for Preparing HazMat Incidents","title":"Guide for Preparing HazMat Incidents","source_type":"guidance","agency":"Pipeline and Hazardous Materials Safety Administration","status":"guidance","official":true,"published_on":"2004-01-01","effective_on":"2004-01-01","summary":"Guide for Preparing HazMat Incidents Document reporting_instructions_rev.pdf (4.16 MB) Guidance on when a company needs a designated agent and how it must be maintained and communicated. Issued Date: Thursday, January 1, 2004","machine_formats":{"json":"https://regulus.evalyn.ai/document/phmsa-guidance-guide-preparing-hazmat-incidents-58df67cb.json","markdown":"https://regulus.evalyn.ai/document/phmsa-guidance-guide-preparing-hazmat-incidents-58df67cb.md"},"app_url":"https://regulus.evalyn.ai/document/phmsa-guidance-guide-preparing-hazmat-incidents-58df67cb","source_url":"https://www.phmsa.dot.gov/hazmat-program-development/data-operations/guide-preparing-hazmat-incidents","body":"Guide for Preparing HazMat Incidents\n\nDocument\n\n reporting_instructions_rev.pdf (4.16 MB)\n\n        Guidance on when a company needs a designated agent and how it must be maintained and communicated.\n\n          Issued Date: Thursday, January 1, 2004\n\n<<<PAGE 1>>>\n\nU.S. Department\nof Transportation\nPipeline and\nHazardous Materials\nSafety Administration\nGuide for Preparing\nHazardous Materials\nIncidents Reports\nRevised January 2004\nSupersedes Previous Edition\n\n<<<PAGE 2>>>\n\nii • Incident Reporting Guidelines\nU.S. Department\nof Transportation\nPipeline and\nHazardous Materials\nSafety Administration\nHazardous Materials\nIncident Reporting\nCONTENTS\nOverview\nWhat Federal Regulation requires me to submit the Report? ............ 1\nWhat is the purpose of the Report? ................................................... 1\nWho must complete the Report? ....................................................... 1\nWhat definitions should I know in order to complete the Report? ...... 1\nWhen must I submit a Written Report (DOT Form F 5800.1)? .......... 2\nWhen is a Report not required? ......................................................... 3\nWhen must I make a Telephonic Report? .......................................... 3\nWhat telephone number do I call to make an Immediate\nNotification of a Hazardous Materials Incident?.............................. 3\nHow long do I have to submit the Written Report? ............................ 4\nAm I required to update the information in the Report? ..................... 4\nHow and where do I submit my completed Report?........................... 4\nHow long must I keep a copy of the Report? ..................................... 4\nWhere must I keep a copy of the Report? ......................................... 4\nHow can I get a blank copy of the DOT Form F 5800.1? ................... 4\nHow long does it take to complete the Report? .................................. 4\nHow can I comment on the length of time needed to\ncomplete the Report or on the amount of information\nrequired in the Report? ................................................................... 4\nInstructions: Completing DOT Form F 5800.1\nPart I: Report Type ............................................................................. 5\nPart II: General Incident Information .................................................. 5\nPart III: Packaging Information .......................................................... 6\nPart IV: Consequences ....................................................................... 7\nPart V: Air Incident Information .......................................................... 8\nPart VI: Description of Events and Packaging Failure ....................... 8\nPart VII: Recommendations/Actions Taken to Prevent\nFuture Incidents .............................................................................. 8\nPart VIII: Contact Information ............................................................ 8\nFailure Codes. ............................................................................... 9\nIncident Reporting Requirements (Effective January, 2005)\nSection 171.15 Immediate Notice of Certain Hazardous\nMaterials Incidents. ......................................................................... 11\nSection 171.16 Detailed Hazardous Materials Incident Reports ....... 11\nHazardous Materials Incident Report Form:\nDOT Form F 5800.1 (01-2004) ....................................................... 13\nPHH50-0038-0604\n\n<<<PAGE 3>>>\n\nOverview\nHazardous Materials Incident Report\nDepartment of Transportation Form F 5800.1\nWhat Federal Regulation Requires\nMe To Submit the Report?\nThe Hazardous Materials Regulations\n(HMR; 49 CFR Parts 171-180) require\ncertain types of incidents be reported to\nthe Pipeline and Hazardous Materials\nSafety Administration (PHMSA). Section\n171.15 of the HMR requires an immediate\ntelephonic report (within 12 hours) of\ncertain types of hazardous materials\nincidents. Section 171.16 requires a\nwritten report for certain types of\nhazardous materials incidents within 30\ndays of the incident, and a follow-up\nwritten report within one year of the\nincident, based on certain circumstances.\nEach type of report is explained below.\n(The full text of these sections is at the end\nof the instructions.)\nWhat is the Purpose of the Report?\nThe information you are providing in this\nreport is fundamental to hazardous\nmaterial transportation risk analysis and\nrisk management by government and\nindustry. It allows us to better understand\nthe causes and consequences of\nhazardous material transportation\nincidents. The data is used to identify trends\nand provide basic program performance\nmeasures. It helps to demonstrate the\neffectiveness of existing regulations and\nto identify areas where changes should be\nconsidered. It also assists all parties,\nincluding industry segments and individual\ncompanies, to understand the types and\nfrequencies of incidents, what can go\nwrong, and possible measures that would\nprevent their recurrence. Your accurate and\ncomplete description of incidents can make\na significant contribution to continual safety\nimprovement through better regulations,\ncooperative partnerships, and individual\nefforts.\nWho Must Complete the Report?\nAny person in possession of a hazardous\nmaterial during transportation, including\nloading, unloading and storage incidental\nto transportation, must report to the\nDepartment of Transportation (DOT) if\ncertain conditions are met. This means that\nwhen the conditions apply for completing\nthe report, the entity having physical\ncontrol of the shipment is responsible for\nfilling out and filing DOT Form F 5800.1.\nGenerally, the entity having physical\ncontrol of the shipment during\ntransportation will be the carrier. For\nincidents that occur when a hazardous\nmaterial is stored temporarily during\ntransportation, the entity in physical\npossession of the shipment may be a\nwarehouse or similar storage facility.\nLoading operations. Incidents that occur\nwhile a shipper is loading a hazardous\nmaterial onto a transport vehicle or into a\nbulk packaging, such as a cargo tank,\nportable tank, or rail tank car, before the\ncarrier arrives at the facility to pick up the\nshipment are not required to be reported\nbecause these incidents occur prior to the\nonset of transportation in commerce.\nIncidents that occur while the carrier that\nwill be transporting the hazardous\nmaterial is observing or participating in\nloading operations must be reported\nbecause the carrier is deemed to be in\npossession of the hazardous material at\nthat point; thus, these incidents occur\nduring transportation. For these incidents,\nthe carrier must complete the report.\nUnloading operations. Incidents that occur\nor are discovered while a consignee is\nunloading a hazardous material from a\ntransport vehicle or bulk packaging after\nthe carrier has delivered the material are\nnot required to be reported because these\nincidents occur after transportation has\nended. Incidents that occur while the\ncarrier that delivered the hazardous\nmaterial is observing or participating in\nunloading operations must be reported\nbecause the carrier is deemed to be in\npossession of the hazardous material at\nthat point; thus, these incidents occur\nduring transportation. For these incidents,\nthe carrier must complete the report.\nWhat Definitions Should I Know in\nOrder to Complete the Report?\nIn order to accurately complete the report,\nyou should be familiar with the following\nterms. A complete list of definitions is\ncontained in § 171.8.\nBulk packaging—a packaging, other than\na vessel or a barge, including a transport\nvehicle or freight container, in which haz-\nardous materials are loaded with no in-\nOVERVIEW • 1\ntermediate form of containment and that\nhas:\n(1) A maximum capacity greater\nthan 450 liters (119 gallons) as a\nreceptacle for a liquid;\n(2) A maximum net mass greater than\n400 kilograms (822 pounds) and\na maximum capacity greater than\n450 liters (119 gallons) as a\nreceptacle for a solid; or\n(3) A water capacity greater than\n454 kilograms (1,000 pounds) as\na receptacle for a gas as defined\nin § 173.115.\nCargo tank—a bulk packaging that is:\n(1) A tank intended primarily for the\ncarriage of liquids or gases and\nincludes appurtenances, reinforce-\nments, fittings, and closures;\n(2) Permanently attached to or forms\na part of a motor vehicle, or is\nnot permanently attached to a\nmotor vehicle but which, by\nreason of its size, construction, or\nattachment to a motor vehicle, is\nloaded or unloaded without\nbeing removed from the motor\nvehicle; and\n(3) Not fabricated under a specifica-\ntion for cylinders, intermediate\nbulk containers, multi-unit tank car\ntanks, portable tanks, or tank\ncars.\nHazardous material—a substance or ma-\nterial that has been determined to be ca-\npable of posing an unreasonable risk to\nhealth, safety, and property when trans-\nported in commerce, and that has been\nso designated. The term includes hazard-\nous substances, hazardous wastes, marine\npollutants, elevated temperature materials,\nmaterials designated as hazardous under\nthe provisions of § 172.101, the Hazard-\nous Materials Table (HMT), and materials\nthat meet the defining criteria for hazard\nclasses and divisions in Part 173.\nHazardous substance—a material, includ-\ning its mixtures and solutions, that—\n(1) Is listed in Appendix A to\n§ 172.101;\n(2) Is in a quantity, in one package,\nwhich equals or exceeds the re-\nportable quantity (RQ) listed in Ap-\npendix A to § 172.101; and\n\n<<<PAGE 4>>>\n\n2 • OVERVEIW\nTable 1 Reportable Quantities.\n(3) When in a mixture or solution—\n(i) For radionuclides, conforms\nto paragraph 7 of Appendix\nA to § 172.101.\n(ii) For other than radionclides, is\nin a concentration by weight\nwhich equals or exceeds the\nconcentration corresponding\nto the RQ of the material, as\nshown in Table 1.\nThe term hazardous substance does not\ninclude petroleum, including crude oil or\nany fraction thereof which is not otherwise\nspecifically listed or designated as a\nhazardous substance in Appendix A to\n§ 172.101, and the term does not include\nnatural gas, natural gas liquids, liquefied\nnatural gas, or synthetic gas useable for\nfuel (or mixtures of natural gas and such\nsynthetic gas).\nHazardous waste—any material that is\nsubject to the Hazardous Waste Manifest\nRequirements of the U.S. Environmental\nProtection Agency specified in 40 CFR Part\n262.\nLoading incidental to movement —load-\ning by carrier personnel or in the pres-\nence of carrier personnel of packaged or\ncontainerized hazardous material onto a\ntransport vehicle, aircraft, or vessel for the\npurpose of transporting it, including the\nloading, blocking, and bracing of a haz-\nardous materials package in a freight con-\ntainer or transport vehicle, and segregat-\ning a hazardous material in a freight con-\ntainer or transport vehicle from incompat-\nible cargo. For a bulk packaging, load-\ning incidental to movement means filling\nthe packaging with a hazardous material\nfor the purpose of transporting it. Load-\ning incidental to movement includes\ntransloading.\nMarine pollutant—a material that is listed\nin Appendix B to § 172.101 (also see\n§ 171.4) and, when in a solution or mix-\nture of one or more marine pollutants, is\npackaged in a concentration that equals\nor exceeds:\n(1) Ten percent by weight of the solu-\ntion or mixture for materials listed\nin Appendix B; or\n(2) One percent by weight of the so-\nlution or mixture for materials that\nare identified as severe marine\npollutants in Appendix B.\nMovement—the physical transfer of a\nhazardous material from one geographic\nlocation to another by rail car, aircraft,\nmotor vehicle, or vessel.\nStorage incidental to movement— storage\nof a transport vehicle, freight container,\nor package containing a hazardous\nmaterial by any person between the time\nthat a carrier takes physical possession of\nthe hazardous material for the purpose of\ntransporting it until the package containing\nthe hazardous material is physically\ndelivered to its destination.\nTransloading—the transfer of a hazardous\nmaterial from one bulk packaging to\nanother bulk packaging, from a bulk\npackaging to a non-bulk packaging, or\nfrom a non-bulk packaging to a bulk\npackaging for the purpose of continuing\nthe movement of the hazardous material\nin commerce.\nTransportation—the movement of property\nand loading, unloading, or storage\nincidental to that movement.\nUndeclared hazardous material—a\nhazardous material that is:\n(1) Subject to any of the hazard com-\nmunication requirements in sub-\nparts C (Shipping Papers), D\n(Marking), E (Labeling), and F\n(Placarding) of Part 172 of this\nsubchapter, or an alternative\nmarking requirement in Part 173\nof this subchapter (such as\n§§ 173.4(a)(10) and 173.6(c));\nand\n(2) Offered for transportation in com-\nmerce without any visible indica-\ntion to the person accepting the\nhazardous material for transpor-\ntation that a hazardous material\nis present, on either an accom-\npanying shipping document, or\nthe outside of a transport vehicle,\nfreight container, or package.\nUnintentional release—the escape of a\nhazardous material from a package on an\noccasion not anticipated or planned. This\nincludes releases resulting from collision,\npackage failures, human error, criminal\nactivity, negligence, improper packing, or\nunusual conditions such as the operation of\npressure relief devices as a result of over-\npressurization, overfill, or fire exposure. It\ndoes not include releases, such as venting\nof packages, where allowed, and the\noperational discharge of contents from\npackages.\nUnloading incidental to movement—\nremoving a packaged or containerized\nhazardous material from a transport\nvehicle, aircraft, or vessel, or, for a bulk\npackaging, emptying a hazardous material\nfrom the bulk packaging after the\nhazardous material has been delivered to\nthe consignee when performed by carrier\npersonnel or in the presence of carrier\npersonnel.\nAdditionally, for purposes of reporting on\nthis form, the following definitions apply:\nLading retention system—a lading retention\nsystem consists of those items or equipment\nthat provide containment of hazardous\nmaterials at some point during transporta-\ntion, including loading and unloading. The\ncargo tank shell, associated piping, and\nvalves are an example of a lading reten-\ntion system. Dents or damage to a tank\nrequiring repair to an accident protection\nsystem guarding the tank are examples of\nincidents that must be reported. Paint chips\nand scratches to either the tank or the acci-\ndent protection system are examples of in-\ncidents that do not require reporting.\nMajor transportation artery—a highway,\nmain road or secondary road but not a\nside street or dirt road. In the case of rail,\nany rail line except a rail spur.\nWhen Must I Submit a Written\nReport (DOT Form F 5800.1)?\nUnder § 171.16, you must submit a written\nreport within 30 days after any of the\nfollowing:\n• An incident that was reported by\ntelephonic notice under\n§ 171.15;\n• An unintentional release (see\ndefinitions) of a hazardous\nmaterial during transportation\nincluding loading, unloading and\ntemporary storage related to\ntransportation;\n• A hazardous waste is released;\n\n<<<PAGE 5>>>\n\nOVERVIEW • 3\nTable 2 Examples to Clarify When to Report Structural Damage to a Specification Cargo Tank.\n• An undeclared shipment with no\nrelease is discovered; or\n• A specification cargo tank 1,000\ngallons or greater containing any\nhazardous materials that—\n(1) Received structural damage\nto the lading retention system\nor damage that requires\nrepair to a system intended\nto protect the lading retention\nsystem, and\n(2) Did not have a release.\nTo clarify the requirement for a report\nbased on structural damage to a\nspecification cargo tank, Table 2 illustrates\nsome examples.\nWhen Is a Report Not Required?\nYou are not required to report a release\nof a hazardous material if ALL of the\nfollowing apply:\n• The shipment is not being offered\nfor transportation or being\ntransported by air;\n• None of the criteria in\n§ 171.15(a) applies;\n• The material is not a hazardous\nwaste;\n• The material is properly classed\nas an ORM-D, or a Packing\nGroup III material in Class or\nDivision 3, 4, 5, 6.1, 8, or 9;\n• Each package has a capacity of\nless than 20 liters (5.2 gallons)\nfor liquids or less than 30 kg (66\npounds) for solids;\n• The total aggregate release is\nless than 20 liters (5.2 gallons)\nfor liquids or less than 30 kg (66\npounds) for solids;\n• The material does not meet the\ndefinition of an undeclared\nhazardous material in § 171.8;\nand\n• The shipment is an undeclared\nmaterial discovered in an air\npassenger’s checked or carry-on\nbaggage during the airport\nscreening process.\nAlso, you are not required to report\nreleases of minimal amounts of material\n(i.e., a pint or less) released from the\nmanual operation of seals of pumps,\ncompressors, or valves, during the\nconnecting or disconnecting of loading\nand unloading lines, or, for materials for\nwhich venting is authorized, from vents,\nprovided these releases do not result in\nproperty damage or trigger any of the\ntelephonic notifications requirements\nfound in § 171.15.\nWhen Must I Make a Telephonic\nReport?\nUnder § 171.15, you must provide\ntelephone notice within 12 hours\nafter the incident occurs when one of the\nfollowing conditions occurs during the\ncourse of transportation and is a direct\nresult of the hazardous material:\n• A person is killed;\n• A person receives an injury\nrequiring admittance to a\nhospital;\n• The general public is evacuated\nfor one hour or more;\n• One or more major\ntransportation arteries or facilities\nare closed for one hour or more;\n• The operational flight plan or\nroutine of an aircraft is altered;\n• Fire, breakage, spillage or\nsuspected radioactive\ncontamination occurs involving a\nradioactive material;\n• Fire, breakage, spillage or\nsuspected contamination occurs\ninvolving an infectious substance\nother than a diagnostic specimen\nor regulated medical waste;\n• There is a release of a marine\npollutant in a quantity exceeding\n450 liters (119) gallons for\nliquids or 400 kilograms (882\npounds) for solids; or\n• A situation exists of such a nature\nthat in the judgment of the person\nin possession of the hazardous\nmaterial, it should be reported to\nDOT’s National Response Center\n(NRC) even though it does not\nmeet the above criteria.\nYou may decide that the situation should\nbe reported even though it does not meet\nany of the above criteria. Make sure that\nyou request the NRC report number when\nyou make your telephonic report.\nWhat Telephone Number Do I\nCall to Make an Immediate\nNotification of a Hazardous\nMaterials Incident?\nYou must call 800-424-8802 (toll-free) or\n202-267-2675 (toll call) to make a\ntelephonic incident report. This is the\nnumber to the NRC.\n\n<<<PAGE 6>>>\n\n4 • INSTRUCTIONS\nThis call must be made within 12 hours of\nthe events that trigger this requirement.\nIf the incident involves an infectious\nsubstance, you may notify the Director,\nCenter for Disease Control and Prevention\n(CDC), U.S. Public Health Service,\nAtlanta, Georgia, toll free at 800-232-\n0124. If a discrepancy of a shipment\nintended for air is discovered following\nits acceptance aboard aircraft, notify the\nnearest Federal Aviation Administration\nCivil Aviation Security Office as soon as\npractical.\n• You can submit the report on-line\nat http://hazmat.dot.gov.\nHow Long Must I Keep a Copy of\nthe Report?\nYou must keep a copy of each report or\nan electronic image of the report for two\nyears after the date you submit it to\nPHMSA (§ 171.16(b)(3)).\nWhere Must I Keep a Copy of the\nReport?\nThe report must be accessible through your\ncompany’s principal place(s) of business.\nHow Long Do I Have to Submit\nYou must be able to make the report avail-\nthe Written Report?\nable upon request to authorized represen-\nYou must submit your written report within\ntatives or a special agent of the Depart-\n30 days of discovery of the incident, 30 days of discovery of the incident, 30 days of discovery of the incident, 30 days of discovery of the incident, 30 days of discovery of the incident,\nment within 24 hours of such a request\n§ 171.16(a).\n(§ 171.16(b)(3)).\nAm I Required to Update the\nInformation in the Report?\nYes. You must use DOT Form F 5800.1\nand check the “A supplemental (follow-up)\nreport” box on question #2 to provide\nadditional information after the initial re-\nport. You are required to provide updates\nfor up to one year after the initial filing if\nmore information is gained or new devel-\nopments arise concerning the following,\nfor example:\n• A death results from injuries\ncaused by a hazardous material;\n• The person responsible for pre-\nparing the original report learns\nthat there is a misidentification\nof hazardous material or pack-\nage information;\n• Damage or loss or related costs\nthat were not known at the time\nthe report was filed become\nknown; or\n• Revised estimates of damages,\nlosses, and related costs result in\na change of $25,000 or more,\nor 10% of the original cost esti-\nmates, whichever is greater, even\nif the original estimate was un-\nder $500.\nHow and Where Do I Submit My\nCompleted Report?\n• You can mail paper copies of the\nreport to the Information Systems\nManager, U.S. Department of\nTransportation, Pipeline and\nHazardous Materials Safety\nAdministration, Office of\nHazardous Materials Safety,\nPHH-63, Washington, DC\n20590-0001; or\nHow Can I Get a Blank Copy of\nthe DOT Form F 5800.1?\nThere are a variety of sources for obtain-\ning the DOT Form F 5800.1. Please note\nthat you are allowed to make unlimited\nphotocopies of the form and distribute\nthem.\n• You may obtain limited copies of\nthe form from the Information\nSystems Manager at the above\naddress.\n• You may download a copy of the\nform from our website at\nhttp://hazmat.dot.gov/spills.htm\n• Our Fax on Demand service has\ncopies of the instructions and the\nform. Call 800-467-4922 and\nchoose the Fax on Demand op-\ntion #2.\nHow Long Does It Take To\nComplete the Report?\nPHMSA anticipates that it will take you\napproximately 1.6 hours to complete this\nreport. This estimate includes the time it\nwill take you to review the instructions,\nsearch your existing data sources for in-\nformation, gather the required data, and\ncomplete and review the report.\nHow Can I Comment on the\nLength of Time Needed to\nComplete the Report or on the\nAmount of Information Required\nin the Report?\nYou can send your comments on the\nreport, and any suggestions you have for\nreducing the amount of time needed to\ncomplete the report, to the following\naddress:\n(1) Information Systems Manager,\nU.S. Department of\nTransportation, Pipeline and\nHazardous Materials Safety\nAdministration, Office of\nHazardous Materials Safety,\nPHH-63, Washington, DC\n20590-0001.\nPlease verify that your information is\naccurate. Although the required\ninformation is generally available at the\ntime of the incident, you may need to do\nsome additional investigation in order to\nobtain all of the facts pertaining to deaths,\ninjuries or damage amounts. If you submit\ncomplete and accurate information at the\ntime you file the report, it will decrease\nthe chance of your having to supply\nmissing information to DOT at a later date.\nPHMSA may follow up on incomplete\nforms.\n\n<<<PAGE 7>>>\n\nInstructions\nCompleting DOT Form F 5800.1\nPlease print. Fill in all applicable blanks\naccurately to the best of your ability.\nPart I: Report Type\n(1) This is to report: Check the box that\ndescribes why you are filling out this\nform. This will normally be “A) A\nhazardous material incident.” If you\nare reporting an undeclared\nshipment with no release, check the\ncorresponding box, “B).” If you are\nreporting an incident involving a\ncargo tank motor vehicle containing\na hazardous material that received\nstructural damage to the lading\nretention system that may affect its\nability to retain lading but does not\nrelease a hazardous material, check\nthat appropriate box, “C).”\n(2) Indicate what type of report this is:\nIf this is an initial report, check the\n“initial report” box. If this is a\nfollow-up to a previous report, check\nthe “A supplemental (follow-up)\nreport” box. If you are using\nadditional pages, check the\n“Additional Pages” box.\nPart II: General Incident\nInformation\n(3), (4) Date & Time of Incident: Enter the\ndate and time the incident occurred.\nIf you do not know the actual date\nand time, give the date and time\nyou discovered the incident. Use\n24-hour time for the incident time\n(e.g., “2400” for midnight, “1200”\nfor noon, “0747” for 7:47 a.m.,\n“2115” for 9:15 p.m.).\n(5) Enter National Response Center\nReport Number: If this incident was\nreported to the NRC, fill in the\nreport number NRC assigned to the\nincident.\n(6) If you submitted a report to another\nFederal DOT agency, enter the\nagency and report number: If you\nwere required to fill out a report for\nanother federal agency such as the\nFederal Railroad Administration\n(FRA) or the Federal Motor Carrier\nSafety Administration (FMCSA) for\nthis incident, please include the\nagency and report number. This will\nfacilitate our combination of\ninformation.\n(7) Location of Incident: Enter the geo-\ngraphic location of the incident\n(city, county, state, and zip code).\nIf you do not know the actual loca-\ntion where the incident occurred,\ngive the location where it was dis-\ncovered. If the incident occurred\nat an airport or rail yard, include\nthe name of the facility. If the inci-\ndent occurred on a body of water,\ninclude the name and/or river mile.\nIf you do not know the street ad-\ndress, or if the incident occurred\non a highway, include a descrip-\ntion such as “On I-70, mile marker\n240.”\n(8) Mode of Transportation: Enter\nthe code that corresponds to the\nmode of transportation in which the\nincident occurred or was discov-\nered. If the incident occurred or\nwas discovered in an in-transit stor-\nage area (e.g., a terminal or ware-\nhouse), check the box that corre-\nsponds to the mode by which the\npackage was last transported.\n(9) Transportation Phase: Enter the\ncode that describes where the in-\ncident occurred in the transporta-\ntion system. In transit means\nthe incident occurred or was first\ndiscovered while the package was\nin the process of being transported.\nIn-transit storage is storage inci-\ndental to transportation, such as at\na terminal waiting for the next leg\nof transportation.\n(10) Carrier/Reporter: Provide the\nname, street address, Federal DOT\nnumber (if applicable), and hazmat\nregistration number of the carrier\nor the entity who is reporting the\nincident (if other than a carrier). The\nentity in physical possession of the\nmaterial when the incident oc-\ncurred or was discovered must re-\nport the incident.\n(11) Shipper/Offeror: Enter the informa-\ntion about the person or entity that\noriginally offered for transportation\nthe material or package involved\nin the incident.\n(12) Origin: Enter the origin of the ship-\nment if the address is different than\nthe shipper/offeror information\nentered in item #11.\nINSTRUCTIONS • 5\n(13) Destination: Enter the final destina-\ntion of the shipment involved in the\nincident.\n(14) through (19):\nHazardous Material Description:\nEnter the proper shipping name,\ntechnical or trade name, hazard\nclass or division, ID number,\npacking group, and amount of\nmaterial released. All of this\ninformation, except the amount of\nmaterial released, can be found on\nthe shipping papers that\naccompany the shipment,\n§ 172.202. When indicating the\namount of material released,\ninclude units of measurements\n(e.g.: 115 gallons, 69 tons).\n(20) Was the material shipped as a\nhazardous waste? Check the “Yes”\nbox if the material meets the defi-\nnition of a hazardous waste in §\n171.8 (requires an EPA Uniform\nHazardous Waste Manifest). In-\nclude the EPA Manifest number.\n(21) (22) (23) Is this a Toxic by Inhalation (TIH)\nmaterial? If the material involved\nin the incident meets the definition\nof a Toxic by inhalation material in\n§ 173.132, check the \"Yes\" box\nand enter the Hazard Zone in the\nspace provided.\nWas the material shipped under an\nExemption, Approval, or Compe-\ntent Authority Certificate? If the\nshipment was shipped under an ex-\nemption, an approval, or a Com-\npetent Authority Certificate, check\nthe “Yes” box and provide the ap-\npropriate assigned number.\nWas this an undeclared hazardous\nmaterials shipment? If this material\nwas not indicated in any way to\nbe a hazardous material even\nthough it was required to be de-\nscribed as such on a shipping pa-\nper, or if the material would nor-\nmally be excepted from the ship-\nping paper requirements (such as\na small quantity material) and does\nnot have the required markings, it\nis considered an undeclared haz-\nardous material shipment. Check\nthe appropriate box.\n\n<<<PAGE 8>>>\n\n6 • INSTRUCTIONS\nTable 3 Non-bulk and IBC Packaging Identification Codes.\nPart III: Packaging Information\n(24) (25) Packaging Type: Check the box that\ncorresponds to the type of packag-\ning involved in the incident. If more\nthan one packaging type was in-\nvolved in an incident, reproduce\nPart III of the form and fill out this\nsection for each of the packaging\ntypes. For example, if three differ-\nent packaging types were involved\nin an incident, fill out a separate\nPart III for each packaging type. If\nthe type of packaging is not repre-\nsented, check the “Other” box and\nenter a brief description such as\n“non-specification bulk bin.”\nEnter the appropriate failure codes\n(found at the end of the instructions):\nEnter the codes that describe what\nfailed on the packaging, how the\npackaging failed, and the cause(s)\nof the failure. Be sure to enter the\ncodes from the list that corresponds\nto the particular packaging types\nchecked above (#24). Enter the\nmost important failure point in line\n1. If there is a second failure point,\nenter in line 2. If there are more\nthan two failure points, provide ad-\nditional information in this format in\nPart VI. The following explains the\ncontent of each line:\nWhat Failed: You can enter\nup to 2 “What Failed” codes\nto describe the part of the pack-\naging that fails and was the im-\nmediate cause of the release.\nOften, on a simple packaging,\nonly one code will be required.\nOn more complex packaging,\nadditional entries will help\nidentify where that failure oc-\ncurred. The first entry should\ndesignate the specific point of\nfailure, followed by entries that\nhelp identify where that failure\noccurred. For instance, a dete-\nriorated gasket on a pipe\nflange on the liquid line would\nhave failure code 121 for gas-\nket entered first and failure\ncode 118 for flange entered\nsecond.\nHow Failed: Enter the “Fail-\nure” code that describes how\nthe corresponding part of the\npackaging failed. The primary\nway the packaging failed\nshould be entered first.\nCause(s) of Failure: Enter the\n“Cause of Failure” code that\ndescribes what caused the cor-\nresponding part of the packag-\ning to fail in the way it did. The\nmost probable or fundamental\ncause of failure should be en-\ntered first.\nIf none of the codes on the list fit exactly,\nuse the closest match and provide\nadditional detail in Part VI. Also, if you\nbelieve a better set of codes would be\nmore descriptive of what failed, how it\nfailed, and the causes of failure, suggest\nthem in Part VII.\n(26a) Provide the complete packaging\nidentification markings, if avail-\nable: Every specification packag-\ning, UN or DOT, has a packaging\nidentification printed or stamped\non it or on a plate attached to the\npackaging. Examples are pro-\nvided on the form.\n(26b) For Non-bulk, IBC, or non-specifi-\ncation packaging: Only fill out 26b\nif the marking is incomplete, de-\nstroyed, or unknown. Fill in the\nOuter and Inner packaging type\nand Material of Construction infor-\nmation, as appropriate. If the pack-\naging is non-bulk or Intermediate\nBulk Container (IBC), use the codes\nin Table 3 to enter the number or\nletter that applies for either non-bulk\nor IBC packaging. For non-bulk,\nIBC or non-specification packaging\nprovide a description of the pack-\naging in the space(s) provided.\n(27) Describe the package capacity and\nthe quantity: Enter the total capacity\nof the inner and outer package.\nAlso enter the actual amount of\nhazardous material that was\nshipped in the package, the\nnumber of packages in the\nshipment, and the number of\npackages that failed. Please\ninclude the units of measurement\n(liter, gallons, pounds, cubic feet,\netc.)\n(28) Provide package construction and\ntest information, as appropriate: In\nthe case of Non-bulk packagings\n\n<<<PAGE 9>>>\n\nor IBCs enter the name of the\npackaging manufacturer or the\nsymbol of the manufacturer only if\ncomplete identification markings\nwere not provided in #26b. Enter\nthe date of manufacture and the\nserial number, if applicable. Enter\nthe last test date if the packaging\nrequires periodic testing. Also\ninclude the design pressure, shell\nthickness, head thickness, and\nservice pressure if the failed\npackagings are of the type\nindicated in parenthesis after each\nquestion. If the packaging\ncontained a valve, or other device\nthat failed and resulted in a\nhazardous material release, enter\nthe valve or device type,\nmanufacturer (if present and\nlegible), and model number (if\npresent and legible).\n(29) If the package is for Radioactive\nMaterials, complete the following:\nComplete this question only if a\nradioactive material was involved.\nIndicate the packaging category,\nthe packaging certification,\ncertification number, and which\nnuclides were present, the\ntransportation index (TI), activity of\nthe nuclides, and the criticality\nsafety index.\nPart IV: Consequences\n(30) Result of Incident: Check all boxes\nthat describe what occurred\nduring the incident or as a result\nof the incident. For example, in\na situation where a truckload of\n55 gallon drums of corrosive\nliquids overturns resulting in a\nrelease that contaminates a\nnearby wetlands and stream the\nboxes “Spillage,” “Material\nEntered Waterway/Storm\nSewer,” and “Environmental\nDamage” may apply.\n(31) Emergency Response: Check all\nboxes that correspond with any\nemergency response and cleanup\ncrews that participated in\nresolving the incident. If a fire\ncrew, EMS, or police unit\nresponded to the incident, include\nthe report number.\n(32) Damages: You are required to\nprovide information on estimated\ndamages if your damages exceed\n$500.00. This figure includes the\ncost of the material lost, property\ndamage, vehicle damage,\nresponse costs, and clean-up\ncosts. If you do not know these\namounts at the time you complete\nthe report, or the actual costs are\nrevised by more than $25,000,\nyou must submit a follow-up report\nafter you determine the amounts.\nThe following definitions explain\neach of the costs:\nMaterial Loss: Enter the value\nof material released and\nunrecoverable. Base this entry\non the amount of material\nreleased multiplied by the unit\nvalue (e.g., price per gallon or\nprice per pound) as listed on\nthe shipper’s invoice. If the\ninvoice is not available,\nestimate the cost per unit using\nthe shipper’s basis.\nCarrier Damage: Enter the\ntotal value of damage incurred\nby the carrier. Major\ncomponents include costs to\nrepair the damaged vehicle\nand costs resulting from\ndamage to cargo. If the\nvehicle is declared “totaled,”\nenter the insured value of the\nvehicle. This entry should not\ninclude damage to other\nproperty or to vehicles owned\nby other persons.\nProperty Damage: Enter the\ntotal value of costs resulting\nfrom damage to the property\nof others involved in the\nincident. These include: repair\nand replacement costs of other\nvehicles; repair and\nreplacement costs to buildings\nand other fixed facilities; and\nrestoration of open land\nbeyond decontamination and\ncleanup.\nResponse Cost: Enter the total\nvalue of response costs.\nResponse costs are those costs\nincurred immediately after the\nincident, and include local\nemergency response from\npolice and fire departments\nand emergency response\nteams, as well as costs\nincurred by the responsible\nparty. Response costs also\ninclude costs to contain the\nhazardous material released.\nINSTRUCTIONS • 7\nRemediation/Cleanup Cost:\nEnter the total value of the cost\nto cleanup and remediate the\nsite. Cleanup costs are those\ncosts incurred to collect,\ntransport, and ultimately\ndispose of all material\ncollected during the response\nphase. Remediation costs are\nthose costs incurred to restore\nthe incident scene to its pre-\nincident state, and could\ninclude excavation, disposal\nand replacement of\ncontaminated soil, pumping,\ntreatment and re-injection of\ncontaminated groundwater, or\nabsorption and disposal of\nhazardous material released\ninto surface water.\n(33a) Did the hazardous material\ncause or contribute to a human\nfatality? If a person was fatally\ninjured by contact with the\nhazardous material or its vapors\nor by a fire or explosion that\nresulted from the hazardous\nmaterial, check the “Yes” box\nand enter the number of fatalities\nthat resulted directly from the\nhazardous material.\n(33b) Were there human fatalities that\ndid not result from the hazardous\nmaterial? If the fatalities were not\ncaused directly by the hazardous\nmaterial, check the “Yes” box\nand enter the number of\nfatalities. An example: if a\npassenger car collided with a\ncargo tank carrying gasoline\nand the automobile driver was\nkilled due to the collision, then\nthe fatality was not caused by\nthe hazardous material released.\nIf, however, the accident resulted\nin the release of gasoline from\nthe cargo tank and a resulting\nfire killed the automobile driver,\nthen the fatality was caused by\nthe hazardous material.\n(34) Did the hazardous material\ncause or contribute to a personal\ninjury? If a person was injured\nby contact with the hazardous\nmaterial or its vapors or by a fire\nor explosion that resulted from\nthe hazardous material, check\nthe “Yes” box and enter the\nnumber of persons injured by the\nhazardous material.\n\n<<<PAGE 10>>>\n\n8 • INSTRUCTIONS\n(35) (36) (37) Hospitalized means admitted to a\nmedical facility, not treated and\nreleased from a facility, such as a\nhospital emergency room, where\nthe person was never admitted to\nthe hospital proper. Non-\nhospitalized individuals are those\nwho may have received attention\nfrom medical personnel on-site or\nat a facility (including hospital\nemergency room), but were not\nadmitted to a medical facility.\nIndicate the number of injured\nemployees,emergency responders\n(firefighters, police, medics, etc.)\nand members of the general\npublic.\nDid the hazardous material cause\nor contribute to an evacuation? If\nthe incident required the\nevacuation or removal of persons\nfrom a specific area because of\npossible or actual contact with the\nhazardous materials involved in\nthe incident, check the “Yes” box.\nSeparately specify the numbers of\nindividuals from the general public\nevacuated and number of\nemployees of the facility or\nworkers in the area that were\nevacuated. Also provide the total\nnumber of individuals evacuated.\nIndicate the duration of the\nevacuation (in hours).\nWas a transportation artery or\nfacility closed? If a road or\ntransportation facility was closed\ndue to the incident, check the\n“Yes” box and indicate the\nduration (in hours) here.\nWas the material involved in a\ncrash or derailment? Check the\n“Yes” box if a hazardous material\nwas involved in a crash or\nderailment. Provide the estimated\nspeed and weather conditions at\nthe time of the crash, such as rain,\nblowing snow, sleet, iced\nroadway, sun glare, fog, dry\npavement, high winds, etc.\nIndicate if the vehicle overturned\nor left the roadway or track.\nPart V: Air Incident Information\nThis section is for incidents with packagings\ntransported or intended for transportation\nby aircraft. If your packaging was not\ntransported or intended to be transported\nby air, skip this section.\n(38) (39) (40) Was the shipment on a passenger\naircraft? Indicate whether the\nshipment in question was on a\ncommercial passenger aircraft. If\nso, indicate if the material was\ntendered (accepted for shipment)\nas cargo, or was located in a\npassenger’s baggage, either in the\ncabin or baggage compartment.\nWhere did the incident occur or\nwhere was the incident\ndiscovered? Indicate where in the\ncourse of t","truncated":true,"body_characters":68398}