REPORT INCIDENT IMMEDIATELY to the KANSAS DIVISION OF EMERGENCY MANAGEMENT (KEM), telephone(785) 296-8013 or (800) 275-0297.  THIS COMPLETED FORM must be mailed to KEM, Technological Hazards Section, 2800 SW Topeka Blvd. ,  Topeka, KS, 66611-1287 or fax to (785) 274-1426 within one business day of verbal report. If the commodity/chemical is an EPCRA EHS or a CERCLA Hazardous Substance a written after action report must be sent to the local LEPC(s) and CEPR/SERC(s) affected within 7 calendar days following the release. Form A(s) may be used as the after action report to KEM ONLY IF an updated Form A is submitted after the incident has concluded and information on any known or anticipated acute or chronic health risks associated with the release is attached.
 

* The following fields may have multiple entries: Commodity, Physical Form, Incident Mode, Truck/Trailer Number, Railcar Number, and placard.