Spills and releases of chemicals, products, and wastes occur occasionally in all healthcare institutions of any size. Most often, spilled substances are not hazardous and pose little or no threat to people. However, sometimes the substance is hazardous and poses a demonstrable threat to the health of persons anywhere in the area. Washington State's Emergency Response standard was first applied to hospitals in February 2005 in a legal settlement. L & I investigators found that hospitals, by virtue of the volumes and variety of hazardous materials commonly stored, used, managed, and disposed of, are subject to the Emergency Response standard of Chapter 296-824 WAC. This manual is designed for use in conjunction with Hazardous Materials (HazMat) Emergency Response training. This training is designed to give you the tools necessary to search for the appropriate information on a spilled or released substance, to assess the hazards presented by the spilled material, to don appropriate personal protective equipment, to clean up the spill, to properly dispose of the substance and the clean-up media, to report your actions for internal documentation, and to report the spill or release to local, regional, state, or federal authorities, if required. It also teaches you how to respond to a spill that may pose hazards beyond your capabilities to safely control.