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Holyoke Community College Laboratory Incident Form
Please fill out this form in the event an incident occurs in a campus laboratory.
Email *
Location of Incident *
Date and Time of Incident *
Please describe what was being at the time of the incident. *
Please describe how the incident occured. *
Please describe what PPE was used, and how much of what chemical was involved if spill/exposure occured.
Was there an Injury?
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If there was an injury, please write the name(s) of the injured, along with their phone number:
If there was exposure to hazardous material, please write which chemical(s) and quantities:
Was a person exposed to biohazards, i.e. blood, saliva, or other? If so please write what.
Persons affiliation with HCC
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Reporting Person's Name, Title and Phone Number:
Description of any action taken in response to incident:
A copy of your responses will be emailed to .
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