Use of Environment Agency supplied equipment form (FM/7/4/11/2)

(*) indicates a required field.

About you

Your name:(*)

Your email address:(*)

Incident details

Incident date:(*)

Incident time:(*)

Incident address:(*)

HFRS incident ref:(*)

Fire incident commander/Hazmat Officer name, rank and station:(*)

Appliance(s) from where EA equipment was used:(*)

Incident location, eg river, roadway etc:(*)

Brief description, eg RTC, overturned tanker, split fuel tank etc:(*)

Likely cause, eg fire run off, spillage, RTC, ruptured fuel tank etc:(*)

Spillage quantity(*)

Spillage type:(*)

Polluter details

Owner/occupier/vehicle registration:(*)

Telephone number:

Pollution prevention

Were any pollution prevention measures deployed before HFRS arrival? Please describe and identify who took action:(*)

Were any improvised actions taken by HFRS, eg use of soil, sand, etc? Please describe:(*)

Environment Agency

Was the Environment Agency informed:(*)Yes No

Did the Environment Agency attend:(*)Yes No

Environment Agency officer (if known):

Equipment and resources

Equipment used (detail all pollution equipment used, not just consumables):(*)

Evaluation of equipment or any other comments:(*)

Total hours of all HFRS personnel allocated to this task:(*)

Type and number of HFRS vehicles deployed:(*)

Date form completed:(*)

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This form will deliver to Community Response Support