Well / Facility Information
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Select the well / facility above and click Use Selected Facility to auto-populate responsible party and location information.

If the incident is not from a well or facility then manually enter the below information as best as possible.

Required fields are marked with * and are still required to be entered.

Submitters Information
Responsible Party
Contact Info
Incident Location Information
Description of spill location if not on well or facility site. (0 of 1000 max characters)
Incident Information

If date of incident is unknown, enter date of discovery.

Enter time in hh:mm 24-hour military time, or select from list.

Distance From Nearest
Estimated Release Volume
Recovered Volume
Description of other released substance. (0 of 150 max characters)
Describe cause of spill or fire. (0 of 4000 max characters)
Size of affected area. (0 of 100 max characters)
Explosive atmosphere, immediate health hazards, etc. (0 of 150 max characters)
Describe impacts or likelihood of impacts to surface water, groundwater, soils, etc. (0 of 4000 max characters)
How spill was contained, action taken to isolate or stop incident, any cleanup activities commenced, evacuation of nearby personnel, emergency approval to burn contaminant, etc. (0 of 4000 max characters)
Where will recovered wastes be disposed? (0 of 1000 max characters)

Enter additional agencies below.

Enter other agenies notified above. (0 of 250 max characters)
If entering multiple e-mail addresses, separate them with a semicolon - do not use spaces. (0 of 250 max characters)
Pressing enter or the submit button will send an e-mail version of this completed Environmental Incident Report to NDDH Environmental Health Section personnel, ND DES and to NDIC Oil and Gas Division personnel.