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CODE OF SECTOR

CODE TYPE OF SECTOR

1 MANUFACTURING
2 MINING AND QUARRYING
3 CONSTRUCTION
4 AGRICULTURE
5 FORESTRY
6 FISHERY
7 LOGGING
8 ELECTRICITY UTILITY
9 GAS UTILITY
10 WATER UTILITY
11 SANITARY UTILITY
12 TRANSPORT
13 STORAGE
14 COMMUNICATION
15 WHOLESALE
16 RETAIL TRADES
17 HOTELS
18 RESTAURANTS
19 FINANCE
20 INSURANCE
21 REAL ESTATE
22 BUSINESS SURVICES
23 PUBLIC SURVICES
24 STATUTORY AUTHORITIES
 APPENDIX 3

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 APPENDIX 4

REGISTER OF CHEMICALS HAZARDOUS TO HEALTH

SECTION A : COMPANY INFORMATION

Name : S Y A R I K A T R K S S D N B H D DOSH Registration No. : S L K 4 1 0 8

(Refer to Appendix 4 for Code of Sector and Appendix 5 for Class of Industry)
Address : 3 3 L I G H T I N D U S T R I A L A R E A

Code of Sector : 0 1

City : S E T A P A K Postcode : 5 3 2 0 0 Class of Industry : 3 5 2 9 0

State : W P E R S E K U T U A N Company Activity (Please enter ( / ) in the appropriate box :

Telephone No. : 0 3 4 2 2 6 0 2 6 Manufacturer : /

Distributor
Formulator :
Email : S S S S S @ P O . J A R I N G . M Y Importer :
End-User :
SECTION B : LIST OF CHEMICALS HAZARDOUS CHEMICAL TO HEALTH

Location : F I N I S H E D P R O D U C T No. of Hazardous Chemical : 3 No. of Workers : Male : 4

Process Operation : F I L L I N G Female : 3

Comply with
Usage Of Classification,
Type of Control Measures Name, Address of Supplier
Name of Physical Form No. of Worker Chemical Name of Active Packaging and Labelling
Product Name CAS No. Regulation, 1977 and Contact Number (Tel.
Chemical of Chemical Exposed Ingredients
No/email)
Engineering CSDS Label
PPE Type # Quantity## Class
Control (Y/N) (Y/N)

Unleaded Not applicable L 3 PVC Glove P 250 86290-81- Gasoline Y Y Y XYZ Malaysia Sdn Bhd, 27 Jln
Gasoline - m3/mth 571-43-2 Ipoh, K. Lumpur
Premium grade Benzene Y Y Y Tel. No. 03-2907170

SAP 9436 Not applicable L 2 Respirator P 3500 1330-20-7 xylene Y Y Y AAA Malaysia Sdn Bhd, Lot 21
m3/mth Senawang Industrial Estate, N.
Sembilan
Tel. No. 06-4056673

SECTION C : NAME OF PERSON WHO PREPARED OF REVIEWED

PREPARED BY : REVIEWED BY :
Name : A L I A H M A D Name : L I M M O I L E N G

Title : S U P E R V I S O R Title : P R O D M A N A G E R

Date : 2 5 0 4 2 0 0 0 Date : 2 5 0 5 2 0 0 0
(Signature) (Signature)
 APPENDIX 5

REGISTER OF CHEMICALS HAZARDOUS TO HEALTH

SECTION A : COMPANY INFORMATION

Name : DOSH Registration No. :

(Refer to Appendix 4 for Code of Sector and Appendix 5 for Class of Industry)
Address :

Code of Sector :

City : Postcode : Class of Industry :

State : Company Activity (Please enter ( / ) in the appropriate box :

Telephone No. : Manufacturer :

Distributor
Formulator :
Email : Importer :
End-User :
SECTION B : LIST OF CHEMICALS HAZARDOUS CHEMICAL TO HEALTH

Location : No. of Hazardous Chemical : No. of Workers : Male :

Process Operation : Female :

Comply with
Usage Of Classification,
Type of Control Measures Name, Address of Supplier
Name of Physical Form No. of Worker Chemical Name of Active Packaging and Labelling
Product Name CAS No. Regulation, 1977 and Contact Number (Tel.
Chemical of Chemical Exposed Ingredients
No/email)
Engineering CSDS Label
PPE Type # Quantity## Class
Control (Y/N) (Y/N)

SECTION C : NAME OF PERSON WHO PREPARED OF REVIEWED

PREPARED BY : REVIEWED BY :
Name : Name :

Title : Title :

Date : Date :
(Signature) (Signature)
SECTION B : LIST OF CHEMICALS HAZARDOUS CHEMICAL TO HEALTH

Location : No. of Hazardous Chemical : No. of Workers : Male :

Process Operation : Female :

Comply with
Usage Of Classification,
Type of Control Measures Name, Address of Supplier
Name of Physical Form No. of Worker Chemical Name of Active Packaging and Labelling
Product Name CAS No. Regulation, 1977 and Contact Number (Tel.
Chemical of Chemical Exposed Ingredients
No/email)
Engineering CSDS Label
PPE Type # Quantity## Class
Control (Y/N) (Y/N)
 Comply with
Usage Of Classification,
Type of Control Measures Name, Address of Supplier
Name of Physical Form No. of Worker Chemical Name of Active Packaging and Labelling
Product Name CAS No. Regulation, 1977 and Contact Number (Tel.
Chemical of Chemical Exposed Ingredients
No/email)
Engineering CSDS Label
PPE Type # Quantity## Class
Control (Y/N) (Y/N)

SECTION C : NAME OF PERSON WHO PREPARED OF REVIEWED

PREPARED BY : REVIEWED BY :
Name : Name :

Title : Title :

Date : Date :
(Signature) (Signature)