# Guide for Preparing HazMat Incidents

- **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
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- **source url:** https://www.phmsa.dot.gov/hazmat-program-development/data-operations/guide-preparing-hazmat-incidents
**body:**

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

<<<PAGE 1>>>

U.S. Department
of Transportation
Pipeline and
Hazardous Materials
Safety Administration
Guide for Preparing
Hazardous Materials
Incidents Reports
Revised January 2004
Supersedes Previous Edition

<<<PAGE 2>>>

ii • Incident Reporting Guidelines
U.S. Department
of Transportation
Pipeline and
Hazardous Materials
Safety Administration
Hazardous Materials
Incident Reporting
CONTENTS
Overview
What Federal Regulation requires me to submit the Report? ............ 1
What is the purpose of the Report? ................................................... 1
Who must complete the Report? ....................................................... 1
What definitions should I know in order to complete the Report? ...... 1
When must I submit a Written Report (DOT Form F 5800.1)? .......... 2
When is a Report not required? ......................................................... 3
When must I make a Telephonic Report? .......................................... 3
What telephone number do I call to make an Immediate
Notification of a Hazardous Materials Incident?.............................. 3
How long do I have to submit the Written Report? ............................ 4
Am I required to update the information in the Report? ..................... 4
How and where do I submit my completed Report?........................... 4
How long must I keep a copy of the Report? ..................................... 4
Where must I keep a copy of the Report? ......................................... 4
How can I get a blank copy of the DOT Form F 5800.1? ................... 4
How long does it take to complete the Report? .................................. 4
How can I comment on the length of time needed to
complete the Report or on the amount of information
required in the Report? ................................................................... 4
Instructions: Completing DOT Form F 5800.1
Part I: Report Type ............................................................................. 5
Part II: General Incident Information .................................................. 5
Part III: Packaging Information .......................................................... 6
Part IV: Consequences ....................................................................... 7
Part V: Air Incident Information .......................................................... 8
Part VI: Description of Events and Packaging Failure ....................... 8
Part VII: Recommendations/Actions Taken to Prevent
Future Incidents .............................................................................. 8
Part VIII: Contact Information ............................................................ 8
Failure Codes. ............................................................................... 9
Incident Reporting Requirements (Effective January, 2005)
Section 171.15 Immediate Notice of Certain Hazardous
Materials Incidents. ......................................................................... 11
Section 171.16 Detailed Hazardous Materials Incident Reports ....... 11
Hazardous Materials Incident Report Form:
DOT Form F 5800.1 (01-2004) ....................................................... 13
PHH50-0038-0604

<<<PAGE 3>>>

Overview
Hazardous Materials Incident Report
Department of Transportation Form F 5800.1
What Federal Regulation Requires
Me To Submit the Report?
The Hazardous Materials Regulations
(HMR; 49 CFR Parts 171-180) require
certain types of incidents be reported to
the Pipeline and Hazardous Materials
Safety Administration (PHMSA). Section
171.15 of the HMR requires an immediate
telephonic report (within 12 hours) of
certain types of hazardous materials
incidents. Section 171.16 requires a
written report for certain types of
hazardous materials incidents within 30
days of the incident, and a follow-up
written report within one year of the
incident, based on certain circumstances.
Each type of report is explained below.
(The full text of these sections is at the end
of the instructions.)
What is the Purpose of the Report?
The information you are providing in this
report is fundamental to hazardous
material transportation risk analysis and
risk management by government and
industry. It allows us to better understand
the causes and consequences of
hazardous material transportation
incidents. The data is used to identify trends
and provide basic program performance
measures. It helps to demonstrate the
effectiveness of existing regulations and
to identify areas where changes should be
considered. It also assists all parties,
including industry segments and individual
companies, to understand the types and
frequencies of incidents, what can go
wrong, and possible measures that would
prevent their recurrence. Your accurate and
complete description of incidents can make
a significant contribution to continual safety
improvement through better regulations,
cooperative partnerships, and individual
efforts.
Who Must Complete the Report?
Any person in possession of a hazardous
material during transportation, including
loading, unloading and storage incidental
to transportation, must report to the
Department of Transportation (DOT) if
certain conditions are met. This means that
when the conditions apply for completing
the report, the entity having physical
control of the shipment is responsible for
filling out and filing DOT Form F 5800.1.
Generally, the entity having physical
control of the shipment during
transportation will be the carrier. For
incidents that occur when a hazardous
material is stored temporarily during
transportation, the entity in physical
possession of the shipment may be a
warehouse or similar storage facility.
Loading operations. Incidents that occur
while a shipper is loading a hazardous
material onto a transport vehicle or into a
bulk packaging, such as a cargo tank,
portable tank, or rail tank car, before the
carrier arrives at the facility to pick up the
shipment are not required to be reported
because these incidents occur prior to the
onset of transportation in commerce.
Incidents that occur while the carrier that
will be transporting the hazardous
material is observing or participating in
loading operations must be reported
because the carrier is deemed to be in
possession of the hazardous material at
that point; thus, these incidents occur
during transportation. For these incidents,
the carrier must complete the report.
Unloading operations. Incidents that occur
or are discovered while a consignee is
unloading a hazardous material from a
transport vehicle or bulk packaging after
the carrier has delivered the material are
not required to be reported because these
incidents occur after transportation has
ended. Incidents that occur while the
carrier that delivered the hazardous
material is observing or participating in
unloading operations must be reported
because the carrier is deemed to be in
possession of the hazardous material at
that point; thus, these incidents occur
during transportation. For these incidents,
the carrier must complete the report.
What Definitions Should I Know in
Order to Complete the Report?
In order to accurately complete the report,
you should be familiar with the following
terms. A complete list of definitions is
contained in § 171.8.
Bulk packaging—a packaging, other than
a vessel or a barge, including a transport
vehicle or freight container, in which haz-
ardous materials are loaded with no in-
OVERVIEW • 1
termediate form of containment and that
has:
(1) A maximum capacity greater
than 450 liters (119 gallons) as a
receptacle for a liquid;
(2) A maximum net mass greater than
400 kilograms (822 pounds) and
a maximum capacity greater than
450 liters (119 gallons) as a
receptacle for a solid; or
(3) A water capacity greater than
454 kilograms (1,000 pounds) as
a receptacle for a gas as defined
in § 173.115.
Cargo tank—a bulk packaging that is:
(1) A tank intended primarily for the
carriage of liquids or gases and
includes appurtenances, reinforce-
ments, fittings, and closures;
(2) Permanently attached to or forms
a part of a motor vehicle, or is
not permanently attached to a
motor vehicle but which, by
reason of its size, construction, or
attachment to a motor vehicle, is
loaded or unloaded without
being removed from the motor
vehicle; and
(3) Not fabricated under a specifica-
tion for cylinders, intermediate
bulk containers, multi-unit tank car
tanks, portable tanks, or tank
cars.
Hazardous material—a substance or ma-
terial that has been determined to be ca-
pable of posing an unreasonable risk to
health, safety, and property when trans-
ported in commerce, and that has been
so designated. The term includes hazard-
ous substances, hazardous wastes, marine
pollutants, elevated temperature materials,
materials designated as hazardous under
the provisions of § 172.101, the Hazard-
ous Materials Table (HMT), and materials
that meet the defining criteria for hazard
classes and divisions in Part 173.
Hazardous substance—a material, includ-
ing its mixtures and solutions, that—
(1) Is listed in Appendix A to
§ 172.101;
(2) Is in a quantity, in one package,
which equals or exceeds the re-
portable quantity (RQ) listed in Ap-
pendix A to § 172.101; and

<<<PAGE 4>>>

2 • OVERVEIW
Table 1 Reportable Quantities.
(3) When in a mixture or solution—
(i) For radionuclides, conforms
to paragraph 7 of Appendix
A to § 172.101.
(ii) For other than radionclides, is
in a concentration by weight
which equals or exceeds the
concentration corresponding
to the RQ of the material, as
shown in Table 1.
The term hazardous substance does not
include petroleum, including crude oil or
any fraction thereof which is not otherwise
specifically listed or designated as a
hazardous substance in Appendix A to
§ 172.101, and the term does not include
natural gas, natural gas liquids, liquefied
natural gas, or synthetic gas useable for
fuel (or mixtures of natural gas and such
synthetic gas).
Hazardous waste—any material that is
subject to the Hazardous Waste Manifest
Requirements of the U.S. Environmental
Protection Agency specified in 40 CFR Part
262.
Loading incidental to movement —load-
ing by carrier personnel or in the pres-
ence of carrier personnel of packaged or
containerized hazardous material onto a
transport vehicle, aircraft, or vessel for the
purpose of transporting it, including the
loading, blocking, and bracing of a haz-
ardous materials package in a freight con-
tainer or transport vehicle, and segregat-
ing a hazardous material in a freight con-
tainer or transport vehicle from incompat-
ible cargo. For a bulk packaging, load-
ing incidental to movement means filling
the packaging with a hazardous material
for the purpose of transporting it. Load-
ing incidental to movement includes
transloading.
Marine pollutant—a material that is listed
in Appendix B to § 172.101 (also see
§ 171.4) and, when in a solution or mix-
ture of one or more marine pollutants, is
packaged in a concentration that equals
or exceeds:
(1) Ten percent by weight of the solu-
tion or mixture for materials listed
in Appendix B; or
(2) One percent by weight of the so-
lution or mixture for materials that
are identified as severe marine
pollutants in Appendix B.
Movement—the physical transfer of a
hazardous material from one geographic
location to another by rail car, aircraft,
motor vehicle, or vessel.
Storage incidental to movement— storage
of a transport vehicle, freight container,
or package containing a hazardous
material by any person between the time
that a carrier takes physical possession of
the hazardous material for the purpose of
transporting it until the package containing
the hazardous material is physically
delivered to its destination.
Transloading—the transfer of a hazardous
material from one bulk packaging to
another bulk packaging, from a bulk
packaging to a non-bulk packaging, or
from a non-bulk packaging to a bulk
packaging for the purpose of continuing
the movement of the hazardous material
in commerce.
Transportation—the movement of property
and loading, unloading, or storage
incidental to that movement.
Undeclared hazardous material—a
hazardous material that is:
(1) Subject to any of the hazard com-
munication requirements in sub-
parts C (Shipping Papers), D
(Marking), E (Labeling), and F
(Placarding) of Part 172 of this
subchapter, or an alternative
marking requirement in Part 173
of this subchapter (such as
§§ 173.4(a)(10) and 173.6(c));
and
(2) Offered for transportation in com-
merce without any visible indica-
tion to the person accepting the
hazardous material for transpor-
tation that a hazardous material
is present, on either an accom-
panying shipping document, or
the outside of a transport vehicle,
freight container, or package.
Unintentional release—the escape of a
hazardous material from a package on an
occasion not anticipated or planned. This
includes releases resulting from collision,
package failures, human error, criminal
activity, negligence, improper packing, or
unusual conditions such as the operation of
pressure relief devices as a result of over-
pressurization, overfill, or fire exposure. It
does not include releases, such as venting
of packages, where allowed, and the
operational discharge of contents from
packages.
Unloading incidental to movement—
removing a packaged or containerized
hazardous material from a transport
vehicle, aircraft, or vessel, or, for a bulk
packaging, emptying a hazardous material
from the bulk packaging after the
hazardous material has been delivered to
the consignee when performed by carrier
personnel or in the presence of carrier
personnel.
Additionally, for purposes of reporting on
this form, the following definitions apply:
Lading retention system—a lading retention
system consists of those items or equipment
that provide containment of hazardous
materials at some point during transporta-
tion, including loading and unloading. The
cargo tank shell, associated piping, and
valves are an example of a lading reten-
tion system. Dents or damage to a tank
requiring repair to an accident protection
system guarding the tank are examples of
incidents that must be reported. Paint chips
and scratches to either the tank or the acci-
dent protection system are examples of in-
cidents that do not require reporting.
Major transportation artery—a highway,
main road or secondary road but not a
side street or dirt road. In the case of rail,
any rail line except a rail spur.
When Must I Submit a Written
Report (DOT Form F 5800.1)?
Under § 171.16, you must submit a written
report within 30 days after any of the
following:
• An incident that was reported by
telephonic notice under
§ 171.15;
• An unintentional release (see
definitions) of a hazardous
material during transportation
including loading, unloading and
temporary storage related to
transportation;
• A hazardous waste is released;

<<<PAGE 5>>>

OVERVIEW • 3
Table 2 Examples to Clarify When to Report Structural Damage to a Specification Cargo Tank.
• An undeclared shipment with no
release is discovered; or
• A specification cargo tank 1,000
gallons or greater containing any
hazardous materials that—
(1) Received structural damage
to the lading retention system
or damage that requires
repair to a system intended
to protect the lading retention
system, and
(2) Did not have a release.
To clarify the requirement for a report
based on structural damage to a
specification cargo tank, Table 2 illustrates
some examples.
When Is a Report Not Required?
You are not required to report a release
of a hazardous material if ALL of the
following apply:
• The shipment is not being offered
for transportation or being
transported by air;
• None of the criteria in
§ 171.15(a) applies;
• The material is not a hazardous
waste;
• The material is properly classed
as an ORM-D, or a Packing
Group III material in Class or
Division 3, 4, 5, 6.1, 8, or 9;
• Each package has a capacity of
less than 20 liters (5.2 gallons)
for liquids or less than 30 kg (66
pounds) for solids;
• The total aggregate release is
less than 20 liters (5.2 gallons)
for liquids or less than 30 kg (66
pounds) for solids;
• The material does not meet the
definition of an undeclared
hazardous material in § 171.8;
and
• The shipment is an undeclared
material discovered in an air
passenger’s checked or carry-on
baggage during the airport
screening process.
Also, you are not required to report
releases of minimal amounts of material
(i.e., a pint or less) released from the
manual operation of seals of pumps,
compressors, or valves, during the
connecting or disconnecting of loading
and unloading lines, or, for materials for
which venting is authorized, from vents,
provided these releases do not result in
property damage or trigger any of the
telephonic notifications requirements
found in § 171.15.
When Must I Make a Telephonic
Report?
Under § 171.15, you must provide
telephone notice within 12 hours
after the incident occurs when one of the
following conditions occurs during the
course of transportation and is a direct
result of the hazardous material:
• A person is killed;
• A person receives an injury
requiring admittance to a
hospital;
• The general public is evacuated
for one hour or more;
• One or more major
transportation arteries or facilities
are closed for one hour or more;
• The operational flight plan or
routine of an aircraft is altered;
• Fire, breakage, spillage or
suspected radioactive
contamination occurs involving a
radioactive material;
• Fire, breakage, spillage or
suspected contamination occurs
involving an infectious substance
other than a diagnostic specimen
or regulated medical waste;
• There is a release of a marine
pollutant in a quantity exceeding
450 liters (119) gallons for
liquids or 400 kilograms (882
pounds) for solids; or
• A situation exists of such a nature
that in the judgment of the person
in possession of the hazardous
material, it should be reported to
DOT’s National Response Center
(NRC) even though it does not
meet the above criteria.
You may decide that the situation should
be reported even though it does not meet
any of the above criteria. Make sure that
you request the NRC report number when
you make your telephonic report.
What Telephone Number Do I
Call to Make an Immediate
Notification of a Hazardous
Materials Incident?
You must call 800-424-8802 (toll-free) or
202-267-2675 (toll call) to make a
telephonic incident report. This is the
number to the NRC.

<<<PAGE 6>>>

4 • INSTRUCTIONS
This call must be made within 12 hours of
the events that trigger this requirement.
If the incident involves an infectious
substance, you may notify the Director,
Center for Disease Control and Prevention
(CDC), U.S. Public Health Service,
Atlanta, Georgia, toll free at 800-232-
0124. If a discrepancy of a shipment
intended for air is discovered following
its acceptance aboard aircraft, notify the
nearest Federal Aviation Administration
Civil Aviation Security Office as soon as
practical.
• You can submit the report on-line
at http://hazmat.dot.gov.
How Long Must I Keep a Copy of
the Report?
You must keep a copy of each report or
an electronic image of the report for two
years after the date you submit it to
PHMSA (§ 171.16(b)(3)).
Where Must I Keep a Copy of the
Report?
The report must be accessible through your
company’s principal place(s) of business.
How Long Do I Have to Submit
You must be able to make the report avail-
the Written Report?
able upon request to authorized represen-
You must submit your written report within
tatives or a special agent of the Depart-
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, 30 days of discovery of the incident,
ment within 24 hours of such a request
§ 171.16(a).
(§ 171.16(b)(3)).
Am I Required to Update the
Information in the Report?
Yes. You must use DOT Form F 5800.1
and check the “A supplemental (follow-up)
report” box on question #2 to provide
additional information after the initial re-
port. You are required to provide updates
for up to one year after the initial filing if
more information is gained or new devel-
opments arise concerning the following,
for example:
• A death results from injuries
caused by a hazardous material;
• The person responsible for pre-
paring the original report learns
that there is a misidentification
of hazardous material or pack-
age information;
• Damage or loss or related costs
that were not known at the time
the report was filed become
known; or
• Revised estimates of damages,
losses, and related costs result in
a change of $25,000 or more,
or 10% of the original cost esti-
mates, whichever is greater, even
if the original estimate was un-
der $500.
How and Where Do I Submit My
Completed Report?
• You can mail paper copies of the
report to the Information Systems
Manager, U.S. Department of
Transportation, Pipeline and
Hazardous Materials Safety
Administration, Office of
Hazardous Materials Safety,
PHH-63, Washington, DC
20590-0001; or
How Can I Get a Blank Copy of
the DOT Form F 5800.1?
There are a variety of sources for obtain-
ing the DOT Form F 5800.1. Please note
that you are allowed to make unlimited
photocopies of the form and distribute
them.
• You may obtain limited copies of
the form from the Information
Systems Manager at the above
address.
• You may download a copy of the
form from our website at
http://hazmat.dot.gov/spills.htm
• Our Fax on Demand service has
copies of the instructions and the
form. Call 800-467-4922 and
choose the Fax on Demand op-
tion #2.
How Long Does It Take To
Complete the Report?
PHMSA anticipates that it will take you
approximately 1.6 hours to complete this
report. This estimate includes the time it
will take you to review the instructions,
search your existing data sources for in-
formation, gather the required data, and
complete and review the report.
How Can I Comment on the
Length of Time Needed to
Complete the Report or on the
Amount of Information Required
in the Report?
You can send your comments on the
report, and any suggestions you have for
reducing the amount of time needed to
complete the report, to the following
address:
(1) Information Systems Manager,
U.S. Department of
Transportation, Pipeline and
Hazardous Materials Safety
Administration, Office of
Hazardous Materials Safety,
PHH-63, Washington, DC
20590-0001.
Please verify that your information is
accurate. Although the required
information is generally available at the
time of the incident, you may need to do
some additional investigation in order to
obtain all of the facts pertaining to deaths,
injuries or damage amounts. If you submit
complete and accurate information at the
time you file the report, it will decrease
the chance of your having to supply
missing information to DOT at a later date.
PHMSA may follow up on incomplete
forms.

<<<PAGE 7>>>

Instructions
Completing DOT Form F 5800.1
Please print. Fill in all applicable blanks
accurately to the best of your ability.
Part I: Report Type
(1) This is to report: Check the box that
describes why you are filling out this
form. This will normally be “A) A
hazardous material incident.” If you
are reporting an undeclared
shipment with no release, check the
corresponding box, “B).” If you are
reporting an incident involving a
cargo tank motor vehicle containing
a hazardous material that received
structural damage to the lading
retention system that may affect its
ability to retain lading but does not
release a hazardous material, check
that appropriate box, “C).”
(2) Indicate what type of report this is:
If this is an initial report, check the
“initial report” box. If this is a
follow-up to a previous report, check
the “A supplemental (follow-up)
report” box. If you are using
additional pages, check the
“Additional Pages” box.
Part II: General Incident
Information
(3), (4) Date & Time of Incident: Enter the
date and time the incident occurred.
If you do not know the actual date
and time, give the date and time
you discovered the incident. Use
24-hour time for the incident time
(e.g., “2400” for midnight, “1200”
for noon, “0747” for 7:47 a.m.,
“2115” for 9:15 p.m.).
(5) Enter National Response Center
Report Number: If this incident was
reported to the NRC, fill in the
report number NRC assigned to the
incident.
(6) If you submitted a report to another
Federal DOT agency, enter the
agency and report number: If you
were required to fill out a report for
another federal agency such as the
Federal Railroad Administration
(FRA) or the Federal Motor Carrier
Safety Administration (FMCSA) for
this incident, please include the
agency and report number. This will
facilitate our combination of
information.
(7) Location of Incident: Enter the geo-
graphic location of the incident
(city, county, state, and zip code).
If you do not know the actual loca-
tion where the incident occurred,
give the location where it was dis-
covered. If the incident occurred
at an airport or rail yard, include
the name of the facility. If the inci-
dent occurred on a body of water,
include the name and/or river mile.
If you do not know the street ad-
dress, or if the incident occurred
on a highway, include a descrip-
tion such as “On I-70, mile marker
240.”
(8) Mode of Transportation: Enter
the code that corresponds to the
mode of transportation in which the
incident occurred or was discov-
ered. If the incident occurred or
was discovered in an in-transit stor-
age area (e.g., a terminal or ware-
house), check the box that corre-
sponds to the mode by which the
package was last transported.
(9) Transportation Phase: Enter the
code that describes where the in-
cident occurred in the transporta-
tion system. In transit means
the incident occurred or was first
discovered while the package was
in the process of being transported.
In-transit storage is storage inci-
dental to transportation, such as at
a terminal waiting for the next leg
of transportation.
(10) Carrier/Reporter: Provide the
name, street address, Federal DOT
number (if applicable), and hazmat
registration number of the carrier
or the entity who is reporting the
incident (if other than a carrier). The
entity in physical possession of the
material when the incident oc-
curred or was discovered must re-
port the incident.
(11) Shipper/Offeror: Enter the informa-
tion about the person or entity that
originally offered for transportation
the material or package involved
in the incident.
(12) Origin: Enter the origin of the ship-
ment if the address is different than
the shipper/offeror information
entered in item #11.
INSTRUCTIONS • 5
(13) Destination: Enter the final destina-
tion of the shipment involved in the
incident.
(14) through (19):
Hazardous Material Description:
Enter the proper shipping name,
technical or trade name, hazard
class or division, ID number,
packing group, and amount of
material released. All of this
information, except the amount of
material released, can be found on
the shipping papers that
accompany the shipment,
§ 172.202. When indicating the
amount of material released,
include units of measurements
(e.g.: 115 gallons, 69 tons).
(20) Was the material shipped as a
hazardous waste? Check the “Yes”
box if the material meets the defi-
nition of a hazardous waste in §
171.8 (requires an EPA Uniform
Hazardous Waste Manifest). In-
clude the EPA Manifest number.
(21) (22) (23) Is this a Toxic by Inhalation (TIH)
material? If the material involved
in the incident meets the definition
of a Toxic by inhalation material in
§ 173.132, check the "Yes" box
and enter the Hazard Zone in the
space provided.
Was the material shipped under an
Exemption, Approval, or Compe-
tent Authority Certificate? If the
shipment was shipped under an ex-
emption, an approval, or a Com-
petent Authority Certificate, check
the “Yes” box and provide the ap-
propriate assigned number.
Was this an undeclared hazardous
materials shipment? If this material
was not indicated in any way to
be a hazardous material even
though it was required to be de-
scribed as such on a shipping pa-
per, or if the material would nor-
mally be excepted from the ship-
ping paper requirements (such as
a small quantity material) and does
not have the required markings, it
is considered an undeclared haz-
ardous material shipment. Check
the appropriate box.

<<<PAGE 8>>>

6 • INSTRUCTIONS
Table 3 Non-bulk and IBC Packaging Identification Codes.
Part III: Packaging Information
(24) (25) Packaging Type: Check the box that
corresponds to the type of packag-
ing involved in the incident. If more
than one packaging type was in-
volved in an incident, reproduce
Part III of the form and fill out this
section for each of the packaging
types. For example, if three differ-
ent packaging types were involved
in an incident, fill out a separate
Part III for each packaging type. If
the type of packaging is not repre-
sented, check the “Other” box and
enter a brief description such as
“non-specification bulk bin.”
Enter the appropriate failure codes
(found at the end of the instructions):
Enter the codes that describe what
failed on the packaging, how the
packaging failed, and the cause(s)
of the failure. Be sure to enter the
codes from the list that corresponds
to the particular packaging types
checked above (#24). Enter the
most important failure point in line
1. If there is a second failure point,
enter in line 2. If there are more
than two failure points, provide ad-
ditional information in this format in
Part VI. The following explains the
content of each line:
What Failed: You can enter
up to 2 “What Failed” codes
to describe the part of the pack-
aging that fails and was the im-
mediate cause of the release.
Often, on a simple packaging,
only one code will be required.
On more complex packaging,
additional entries will help
identify where that failure oc-
curred. The first entry should
designate the specific point of
failure, followed by entries that
help identify where that failure
occurred. For instance, a dete-
riorated gasket on a pipe
flange on the liquid line would
have failure code 121 for gas-
ket entered first and failure
code 118 for flange entered
second.
How Failed: Enter the “Fail-
ure” code that describes how
the corresponding part of the
packaging failed. The primary
way the packaging failed
should be entered first.
Cause(s) of Failure: Enter the
“Cause of Failure” code that
describes what caused the cor-
responding part of the packag-
ing to fail in the way it did. The
most probable or fundamental
cause of failure should be en-
tered first.
If none of the codes on the list fit exactly,
use the closest match and provide
additional detail in Part VI. Also, if you
believe a better set of codes would be
more descriptive of what failed, how it
failed, and the causes of failure, suggest
them in Part VII.
(26a) Provide the complete packaging
identification markings, if avail-
able: Every specification packag-
ing, UN or DOT, has a packaging
identification printed or stamped
on it or on a plate attached to the
packaging. Examples are pro-
vided on the form.
(26b) For Non-bulk, IBC, or non-specifi-
cation packaging: Only fill out 26b
if the marking is incomplete, de-
stroyed, or unknown. Fill in the
Outer and Inner packaging type
and Material of Construction infor-
mation, as appropriate. If the pack-
aging is non-bulk or Intermediate
Bulk Container (IBC), use the codes
in Table 3 to enter the number or
letter that applies for either non-bulk
or IBC packaging. For non-bulk,
IBC or non-specification packaging
provide a description of the pack-
aging in the space(s) provided.
(27) Describe the package capacity and
the quantity: Enter the total capacity
of the inner and outer package.
Also enter the actual amount of
hazardous material that was
shipped in the package, the
number of packages in the
shipment, and the number of
packages that failed. Please
include the units of measurement
(liter, gallons, pounds, cubic feet,
etc.)
(28) Provide package construction and
test information, as appropriate: In
the case of Non-bulk packagings

<<<PAGE 9>>>

or IBCs enter the name of the
packaging manufacturer or the
symbol of the manufacturer only if
complete identification markings
were not provided in #26b. Enter
the date of manufacture and the
serial number, if applicable. Enter
the last test date if the packaging
requires periodic testing. Also
include the design pressure, shell
thickness, head thickness, and
service pressure if the failed
packagings are of the type
indicated in parenthesis after each
question. If the packaging
contained a valve, or other device
that failed and resulted in a
hazardous material release, enter
the valve or device type,
manufacturer (if present and
legible), and model number (if
present and legible).
(29) If the package is for Radioactive
Materials, complete the following:
Complete this question only if a
radioactive material was involved.
Indicate the packaging category,
the packaging certification,
certification number, and which
nuclides were present, the
transportation index (TI), activity of
the nuclides, and the criticality
safety index.
Part IV: Consequences
(30) Result of Incident: Check all boxes
that describe what occurred
during the incident or as a result
of the incident. For example, in
a situation where a truckload of
55 gallon drums of corrosive
liquids overturns resulting in a
release that contaminates a
nearby wetlands and stream the
boxes “Spillage,” “Material
Entered Waterway/Storm
Sewer,” and “Environmental
Damage” may apply.
(31) Emergency Response: Check all
boxes that correspond with any
emergency response and cleanup
crews that participated in
resolving the incident. If a fire
crew, EMS, or police unit
responded to the incident, include
the report number.
(32) Damages: You are required to
provide information on estimated
damages if your damages exceed
$500.00. This figure includes the
cost of the material lost, property
damage, vehicle damage,
response costs, and clean-up
costs. If you do not know these
amounts at the time you complete
the report, or the actual costs are
revised by more than $25,000,
you must submit a follow-up report
after you determine the amounts.
The following definitions explain
each of the costs:
Material Loss: Enter the value
of material released and
unrecoverable. Base this entry
on the amount of material
released multiplied by the unit
value (e.g., price per gallon or
price per pound) as listed on
the shipper’s invoice. If the
invoice is not available,
estimate the cost per unit using
the shipper’s basis.
Carrier Damage: Enter the
total value of damage incurred
by the carrier. Major
components include costs to
repair the damaged vehicle
and costs resulting from
damage to cargo. If the
vehicle is declared “totaled,”
enter the insured value of the
vehicle. This entry should not
include damage to other
property or to vehicles owned
by other persons.
Property Damage: Enter the
total value of costs resulting
from damage to the property
of others involved in the
incident. These include: repair
and replacement costs of other
vehicles; repair and
replacement costs to buildings
and other fixed facilities; and
restoration of open land
beyond decontamination and
cleanup.
Response Cost: Enter the total
value of response costs.
Response costs are those costs
incurred immediately after the
incident, and include local
emergency response from
police and fire departments
and emergency response
teams, as well as costs
incurred by the responsible
party. Response costs also
include costs to contain the
hazardous material released.
INSTRUCTIONS • 7
Remediation/Cleanup Cost:
Enter the total value of the cost
to cleanup and remediate the
site. Cleanup costs are those
costs incurred to collect,
transport, and ultimately
dispose of all material
collected during the response
phase. Remediation costs are
those costs incurred to restore
the incident scene to its pre-
incident state, and could
include excavation, disposal
and replacement of
contaminated soil, pumping,
treatment and re-injection of
contaminated groundwater, or
absorption and disposal of
hazardous material released
into surface water.
(33a) Did the hazardous material
cause or contribute to a human
fatality? If a person was fatally
injured by contact with the
hazardous material or its vapors
or by a fire or explosion that
resulted from the hazardous
material, check the “Yes” box
and enter the number of fatalities
that resulted directly from the
hazardous material.
(33b) Were there human fatalities that
did not result from the hazardous
material? If the fatalities were not
caused directly by the hazardous
material, check the “Yes” box
and enter the number of
fatalities. An example: if a
passenger car collided with a
cargo tank carrying gasoline
and the automobile driver was
killed due to the collision, then
the fatality was not caused by
the hazardous material released.
If, however, the accident resulted
in the release of gasoline from
the cargo tank and a resulting
fire killed the automobile driver,
then the fatality was caused by
the hazardous material.
(34) Did the hazardous material
cause or contribute to a personal
injury? If a person was injured
by contact with the hazardous
material or its vapors or by a fire
or explosion that resulted from
the hazardous material, check
the “Yes” box and enter the
number of persons injured by the
hazardous material.

<<<PAGE 10>>>

8 • INSTRUCTIONS
(35) (36) (37) Hospitalized means admitted to a
medical facility, not treated and
released from a facility, such as a
hospital emergency room, where
the person was never admitted to
the hospital proper. Non-
hospitalized individuals are those
who may have received attention
from medical personnel on-site or
at a facility (including hospital
emergency room), but were not
admitted to a medical facility.
Indicate the number of injured
employees,emergency responders
(firefighters, police, medics, etc.)
and members of the general
public.
Did the hazardous material cause
or contribute to an evacuation? If
the incident required the
evacuation or removal of persons
from a specific area because of
possible or actual contact with the
hazardous materials involved in
the incident, check the “Yes” box.
Separately specify the numbers of
individuals from the general public
evacuated and number of
employees of the facility or
workers in the area that were
evacuated. Also provide the total
number of individuals evacuated.
Indicate the duration of the
evacuation (in hours).
Was a transportation artery or
facility closed? If a road or
transportation facility was closed
due to the incident, check the
“Yes” box and indicate the
duration (in hours) here.
Was the material involved in a
crash or derailment? Check the
“Yes” box if a hazardous material
was involved in a crash or
derailment. Provide the estimated
speed and weather conditions at
the time of the crash, such as rain,
blowing snow, sleet, iced
roadway, sun glare, fog, dry
pavement, high winds, etc.
Indicate if the vehicle overturned
or left the roadway or track.
Part V: Air Incident Information
This section is for incidents with packagings
transported or intended for transportation
by aircraft. If your packaging was not
transported or intended to be transported
by air, skip this section.
(38) (39) (40) Was the shipment on a passenger
aircraft? Indicate whether the
shipment in question was on a
commercial passenger aircraft. If
so, indicate if the material was
tendered (accepted for shipment)
as cargo, or was located in a
passenger’s baggage, either in the
cabin or baggage compartment.
Where did the incident occur or
where was the incident
discovered? Indicate where in the
course of t
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