Lab Events Data Collection

50% of survey complete.

This Lessons Learned input form consists of two pages. The first page is designed to collect the information necessary to describe the incident being reported. The second page is designed to help us understand how this incident relates to a fully developed lab safety program as well as other events in similar laboratories. These questions can also help stimulate thought about ways that the event could have been prevented or preparedness for it improved. After you submit the form, it will be reviewed by members of review committee for clarity. Those submissions which we believe will be helpful to other laboratory workers will be included in our web site collection at

Remember that response to any question is optional, however, the more information you provide, the more helpful the information we collect is likely to be to your fellow scientists. If you are willing to have us contact you with further questions or requests for clarification, you may include your e-mail address at the end of the form. That is the only purpose we will use your e-mail address for. Questions about this form can be directed to

* 1. Narrative description of the event

* 2. Type of Event

* 3. What was the consequence of this incident?

* 4. What was the magnitude of the response?

* 5. Specific Material(s) involved:

* 6. What phase of lab activity did this event occur in?

* 7. Type of laboratory

* 8. Years of experience in this laboratory for the person most directly involved in the incident

* 9. Education level of person most directly involved

* 10. Personal Protective Equipment in use

* 11. Other Relevant Factors Present

* 12. Amount of loss (include any that apply)

* 13. Describe the primary cause of the event

* 14. Is there additional information that would be useful to include about this event? for example, describe any lessons you learned from this event to prevent the incident from recurring.

* 15. Were there any opportunities to improve response to the event after it occurred?

* 16. Source of Information