Critical Incident Report Form: Bio-Lab & Research Archive Power Grid Failure

Campus Building Identifier Code

Campus Zone Location

Facility Primary Function Classification

Containment Level Rating at Time of Incident

Specific Laboratory and/or Archive Designations Affected

Floor Level(s) Affected

Room Numbers or Range

Primary Research Disciplines Conducted in Affected Area

Facility Manager On-Call Contact Number

Did the incident occur during after-hours period (6 PM - 7 AM)?

After-Hours Access Authorization Code

Power Outage Detection Timestamp

Estimated Power Loss Start Timestamp

Actual Power Restoration Timestamp

Total Outage Duration (Minutes)

Critical Temperature Monitoring Points Log

Humidity and Atmospheric Pressure Readings

Environmental Monitoring System Remained Operational Throughout Event?

Describe Monitoring System Failure and Backup Data Sources:

Were Automated Alert Notifications Successfully Transmitted to On-Call Personnel?

Explain Notification Failure and Manual Contact Methods Used:

Personnel Present On-Site at Time of Detection and Subsequent Contacts Made

Containment Integrity Breach Detected (e.g., seal failure, pressure loss, physical damage)?

Immediate Actions Taken to Secure Breach:

Affected Hazardous Materials Inventory Assessment

Specimen Viability Compromised Due to Temperature/Humidity Excursion?

Describe Affected Specimens and Estimated Research Impact:

Decontamination or Sterilization Cycle Required for Any Affected Equipment?

Decontamination Methods to be Employed:

Potential Personnel Exposure to Hazardous Materials Occurred?

Detail Exposure Incident and Medical Surveillance Initiated:

Regulatory or Oversight Bodies Requiring Immediate Notification:

Current Quarantine Status of Affected Area

Upload Photographic Evidence of Containment Systems or Breach Points

Attach Containment System Log Files or Automated Monitoring Reports

Backup Generator Auto-Start Sequence Initiated Successfully?

Time to Accept Full Critical Load (Seconds)

Primary Cause of Auto-Start Failure

Activated Generator Unit Identifier

Fuel Level at Generator Start (Percentage)

Estimated Runtime at Current Load (Hours)

Critical Systems Load Transfer Status Assessment

Systems That Failed to Transfer to Emergency Power and Justification

Manual Load Shedding or System Prioritization Performed?

Detail Load Shedding Decisions and Rationale:

External Rental Generator or Mobile Power Unit Ordered?

Rental Unit ETA and Expected Connection Time:

Utility Provider Escalated for Grid Restoration Timeline?

Utility Provider Ticket Reference and Promised Restoration Time:

Generator Maintenance Compliance Status

Next Scheduled Preventive Maintenance Date

Technical Anomalies or Performance Issues Observed During Generator Operation

Incident Severity Classification (Final)

Facilities Director Full Name

Facilities Director Verification Timestamp

Facilities Director Review Comments and Operational Recommendations

Facilities Director Electronic Signature

Environmental Health & Safety Lead Full Name

EHS Lead Verification Timestamp

EHS Lead Review Comments and Safety Recommendations

Environmental Health & Safety Lead Electronic Signature

Additional Stakeholders Officially Notified

Official Incident Report Reference Number

Report Finalization Status

Summary of Required Corrective and Preventive Actions (CAPA)

Attach Additional Supporting Documentation (e.g., utility provider notices, maintenance logs, photos)