Notification of Hazardous Materials Use
This form must be completed and on file with contracting SU department 72 HOURS prior to the start of a project
Part 1 Project Information
| Project Location | ODC Project # | ||
| SU Contact Name | Star/End Date |
Project Description:
Part 2 Outside Employer Information
| Company Name | Contact | ||
| Company Address | Telephone # | ||
| Site Manager | Site Phone # | ||
| Site Address | Beeper # |
Sub-contracted Outside
Employer Information
Please note : All sub-contractors working with outside employers
must also complete all Multi-Employer Program forms, as
necessary.
| Sub-Contractor | |
| Sub-Contractor | |
| Sub-Contractor |
Part 3 Hazardous
Materials Information
Will Hazardous Materials be used on the job (yes/no)?
If yes, please complete Hazard Identification Form
and attach
| On-site MSDS location: | |
| Method to distribute these MSDSs: |
I certify that the above information is correct to the best of my knowledge. I further understand that any change to the above will require a written amendment.
| Outside Employer Signature: | |
| Date: |
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Syracuse University, 1995
EHO
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Last modified on
November 23, 2005