Hazardous Materials Procurement Request

Hazardous Materials Procurement Request

Date Submitted*

Submitted by (Employee Name)*

Position/Title*

Department*

Building/Room (where chemical will be stored)*

Chemical Name*

Manufacturer

CAS # (if known)

Quantity (specify units)*

Is the chemical a hazardous material per the SDS?*

This information is found on the SDS in section 2, 3, 13, or 15.

Select or enter value

Is the SDS uploaded to RSS?*

Select or enter value

Purpose*

Please provide a brief description for how this material will be used and for what purpose(s).

Storage*

Do you have the proper storage conditions per the SDS?

Select or enter value

Handling*

Have you reviewed the handling requirements of the material and are able to meet the requirements and will train others accordingly?

Select or enter value

PPE*

Please list all PPE indicated for the material required for your planned application.

Send me a copy of my responses