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Chemical Approval Form For Control of Hazardous Products

This document is a chemical approval form used to request and approve new hazardous chemicals. It requires information on the chemical product, intended use, storage, disposal, and safety procedures. It also lists the required personal protective equipment. Key personnel must sign off to indicate their approval including the requisitioner, health and safety consultant, facility manager, and purchasing department. The completed form and material safety data sheet are then distributed to relevant parties.

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948 views1 page

Chemical Approval Form For Control of Hazardous Products

This document is a chemical approval form used to request and approve new hazardous chemicals. It requires information on the chemical product, intended use, storage, disposal, and safety procedures. It also lists the required personal protective equipment. Key personnel must sign off to indicate their approval including the requisitioner, health and safety consultant, facility manager, and purchasing department. The completed form and material safety data sheet are then distributed to relevant parties.

Uploaded by

Ofer Garden
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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CHEMICAL APPROVAL FORM FOR CONTROL OF HAZARDOUS PRODUCTS

DATE: MSDS SHEET ATTACHED: YES NO If No, explain

REQUISITIONER: PHONE #: Facility:

CHEMICAL INFORMATION
PRODUCT TRADE NAME:

CHEMICAL NAME:

MANUFACTURER:

SUPPLIER (if different):

ID THIS PRODUCT: SAMPLE ONLY PERMANENT – NEW ITEM OTHER:

SITE SPECIFIC INFORMATION


INTENDED USE OF CHEMICAL:
INTENDED DATE OF RECEIPT: ORDER QUANTITY:

PROJECTED MAX. INVENTORY: PROJECTED USAGE RATE:

IS THERE AN EXISTING CHEMICAL ON SITE USED FOR SAME PURPOSE? YES NO


WILL THIS NEW PRODUCT REPLACE THE EXISTING CHEMICAL? YES NO
LIST ALTERNATE CHEMICALS CONSIDERED:

TYPE OF CONTAINER FOR THIS CHEMICAL:

PROPOSED CONTAINER DISPOSAL METHOD:

PROPOSED STORAGE LOCATION:

PROPOSED DISPOSAL METHOD OF “SPENT” CHEMICAL:

SPECIAL PROCEDURES PLANNED FOR THIS CHEMICAL:

PERSONAL PROTECTIVE EQUIPMENT REQUIRED FOR THIS CHEMICAL:

ROUTE NAME APPROVAL SIGNATURE DATE APPROVED?


REQUISITIONER YES NO

HSE Consultant John Wong YES NO


Facility Supervisor / Mgr YES NO

Purchasing YES NO

NOTES:

DISTRIBUTION OF APPROVED FORM AND MSDS: To REQUISITIONER / Facility / Facility JH&SC / Purchasing Dept. / HSE Consultant

Prepared by: J. Wong Form #


Release Date: 2/1/2007 Revision #1

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