40 CFR §1604.4

1. (a)The name of, and contact information for, the owner/operator;
2. (b)The name of, and contact information for, the person making the report;
3. (c)The location information and facility identifier;
4. (d)The approximate time of the accidental release;
5. (e)A brief description of the accidental release;
6. (f)An indication whether one or more of the following has occurred:
   1. (1)Fire;
   2. (2)Explosion;
   3. (3)Death;
   4. (4)Serious injury; or
   5. (5)Property damage;
7. (g)The name of the material(s) involved in the accidental release, the Chemical Abstract Service (CAS) number(s), or other appropriate identifiers;
8. (h)If known, the amount of the release;
9. (i)If known, the number of fatalities;
10. (j)If known, the number of serious injuries;
11. (k)Estimated property damage at or outside the stationary source; and
12. (l)Whether the accidental release has resulted in an evacuation order impacting members of the general public and others, and, if known:
    1. (1)The number of persons evacuated;
    2. (2)Approximate radius of the evacuation zone; and
    3. (3)The type of person subject to the evacuation order (i.e., employees, members of the general public, or both).