SECTION B: LIST OF CHEMICALS HAZARDOUS TO

HEALTH

Location: No of Hazardous Chemical: No of Worker: Male:

Process Operations: Female:

Comply with Classification,

Packaging and Labeling
Physical No. of Type of Control Measure Usage of Chemical Name of Name, Address of
Product Name of Regulation,1997 &
form of Worker CAS No. Active Suplier and Contact
Name Chemical CLASS 2013
Chemical Exposed Ingreadients No. (Tel No/Email)
Engineering SDS LABEL
PPE Type* Quantity** CLASS
Control (Y/N) (Y/N)

SECTION C: NAME OF PERSON WHO PREPARED OR

REVIEW

PREPARED
REVIEW BY
BY
Name : Name :
Tittle : Tittle :
Date : (Signature) Date : (Signature)