Syracuse University Hazard Communication Program

Hazard Identification Form

Complete this form for areas where hazardous materials will be used, handled or stored and record the precautionary measures which must be taken.

Date:

Section I: Area Information

To be completed by the Contractor   To be completed by the Work Area Department  
Building/Room #:   Building/Room #:  
Prepared by:   Prepared by:  
Company:   Phone:  
Phone:   Department:  
SU Contact:   Senior occupant:  
Project #:      


Section II: Hazardous Materials Used, Handled Or Stored In The Area

Material Name:  

MSDS On File?
(Yes/No)

Precautionary Measures?
(Yes/No)
Material Name:      
Material Name:      
Material Name:      
Material Name:      
Material Name:      
Material Name:      
Material Name:      
Material Name:      

*Attach additional sheets as necessary

MSDS binder location:  
Access procedure:  

Section III - Precautionary Measures (based on hazards in the area)

Hazard Precautionary Measure Use Date(s) see note**
i.e. sealed bottles of hexane Inform workers not to disturb or open bottles. project duration
i.e. ABC Mastic Remover Workers must wear respirators 15-Jan-95
     
     
     
     
     
     
     

**NOTE: a Precautionary Measures Bulletin must be posted for all materials without a specific use date.

© copyright Syracuse University, 1995

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Last modified on September 01, 2005