Pump/Lift Station: Environmental Event Report

Form Template

Maintain all pump stations in a reliable and ready condition.

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Respond and make repairs quickly to prevent or minimize any negative environmental impact, if a problem does occur. Take quick decisive action to (1) stop the incident and (2) to protect the public from potential health risks in the event of an overflow. Use the Pump/Lift Station: Environmental Event Report mobile app to document events at your pump station that will adversely impact the environment. For any incident that involves an overflow, an Environmental Event Report is filled out. A sample is collected and sent to the laboratory along with an MSD Overflow Monitoring form. The incident is also reported in accordance with the Reporting Procedures listed below. Examples of an Environmental Event Report and an Overflow Sample Collection Form are located in Appendix B.

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