YOURCOMPANY

(ADDRESS)

SAFETY AND LOSS CONTROL PROGRAM

(DATE)
 Table of Contents

Safety Policy Page 3

Assignment of Responsibilities Page 4

Employee Placement Page 4

Indoctrination & Training Page 5

Accident Reporting and Discussions Page 5

Accident Investigation Page 5

Personal Protective Equipment Page 6

Safety Rules and Procedures Page 6

Safety Meetings and Training Page 6

Vehicle Operations Page 7

Safety Inspections Page 8

Hazard Communication Program Page 9

Material Safety Data Sheets

Forms
Accident Investigation Report
Job Site Inspection Checklist

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YOURCOMPANY SAFETY POLICY

SAFETY AND ACCIDENT PREVENTION IS EVERYONE'S RESPONSIBILITY. EACH

EMPLOYEE IS EXPECTED TO FOLLOW ALL COMPANY RULES AND TO PERFORM
THEIR WORK IN A SAFE MANNER. EACH SUPERVISOR AND FOREMAN IS
RESPONSIBILE FOR SAFETY, IMPLEMENTING YOURCOMPANY SAFETY PROGRAM
AND TRAINING EMPLOYEES IN SAFE WORK PROCEDURES. THE
SUPERINTENDENT/FOREMAN HAS THE OVERALL RESPONSIBILITY FOR SAFETY
AT EACH LOCATION. MR./MS ???????????? HAS THE CORPORATE RESPONSIBILITY
AND AUTHORITY FOR SAFETY AND ACCIDENT PREVENTION. THE COMPANY'S
POLICY IS TO PROVIDE A SAFE AND HEALTHY PLACE OF EMPLOYMENT FOR
EVERY EMPLOYEE AND TO ABIDE BY ACCIDENT PREVENTION REGULATIONS SET
PORTH BY THE FEDERAL, STATE AND LOCAL GOVERNMENTS.

YOURCOMPANY IS SINCERELY INTERESTED IN THE SAFETY . AND WELFARE OF

OUR EMPLOYEES. ACCIDENT PREVENTION IS ESSENTIAL IN MAINTAINING AN
EFFICIENT OPERATION.

IT IS OUR POLICY THAT OUR SAFETY RULES SHOULD BE STRICTLY OBSERVED AT

ALL TIMES. ALTHOUGH THESE RULES ARE CONSIDERED TO BE VERY IMPORTANT,
IT IS IMPOSSIBLE TO PUBLISH A RULE TO COVER EVERY CIRCUMSTANCE. IF A
RULE THAT MIGHT COVER.A SPECIFIC HAZARD CONDITION HAS BEEN OMITTED,
THAT SHALL BE NO EXCUSE FOR DISREGARD OF COMMON SENSE IN THE
PERFORMANCE OF YOUR WORK.

THE POSSESSION OR CONSUMPTION OF ALCOHOL, DRUGS OR ANY CONTROL

SUBSTANCE IS AGAINST POLICY AND VIOLATORS ARE SUBJECT TO DISMISSAL.
YOURCOMPANY WILL ASSIST AN EMPLOYEE TO FIND A SUITABLE TREATMENT
FACILITY IF A PROBLEM IS DISCUSSED WITH THEIR SUPERINTENDENT.

EACH EMPLOYEE IS URGED TO COOPERATE FULLY WITH THIS POLICY. ABUSE OR

A DISREGARD OF THIS POLICY IS A VIOLATION OF POLICY AND WILL BE TREATED
ACCORDINGLY. REMEMBER, YOUR HELP IN PREVENTING ACCIDENTS AND
INJURIES BENEFITS YOU AND YOUR FELLOW EMPLOYEES, WE SHOULD ALL
STRIVE FOR A RECORD OF ZERO ACCIDENTS.

__________________________________
President Date

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ASSIGNMENT OF RESPONSIBILITIES:

Company Management
Has overall responsibility for the companys safety program and regularly reaffirms support for
loss control activities
Insures that all employees are informed of top managements commitment to safety and the
abidance of all federal, state, and local regulations.
Establish company safety rules and programs, and provides supervision with the backing,
training and funds to implement these rules and programs.

Safety Coordinator
Responsible for implementation and monitoring the safety program.
Reviews and maintains current copy of all applicable Federal, State, and local safety and health
regulations.
Implements and monitors safety training programs and provides safety materials as needed.
Assists site supervision in accident investigation and recommends controls to prevent a
reoccurrence.
Assures proper notification in the event of an accident.

Supervisors / Foremen
Responsible for the safety of their employees and oversees the compliance with the safety
program and applicable state, federal, and local regulations.
Arranges for prompt medical attention in case of an injury and provides a through written
investigative report with recommendations to prevent a reoccurrence.

Employees
Responsible for learning and abiding by the rules and regulations which are applicable to their
assigned tasks.
Perform their functions in the safest possible manner and encourage co-workers to do likewise.

EMPLOYEE PLACEMENT:

An Employee Questionnaire will be completed on each applicant for employment prior to

placing on the payroll. (Form 1)

The applicant will be interviewed by an YOURCOMPANY supervisor that is familiar with the
physical and mental requirements for the job. Areas that include prior employment, health
record, prior job injuries, and illness will be discussed to assist in determining applicant's
capabilities for performing the job. Notes on the discussion can he recorded an the back of the
Employee Questionnaire.

Where possible to do so, telephone reference checks will be made with at least two prior
employers.

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On employees that will drive a company vehicle or drive their own vehicle and pull the company
trailer, a current, valid driver's license is required The license number and expiration date will be
recorded in the employee's file.

A Motor Vehicle Record (MVR) check will be made on the employees described above at the
time of employment and at least every two years thereafter. When the MVR shows accidents or
violations, the employee's supervisor will counsel this employee to promote a better driving
record.

INDOCTRINATION & TRAINING:

When a new employee is hired, indoctrination training of the employee will be done by the
Superintendent to cover such area as: company safety rules and procedures, personal protective
equipment that is required on the job, what the company expects from the employee, and
YOURCOMPANY Hazard Communication Program to outline any exposures and how to
protect against an exposure potential. The same type of training will be completed at any time
that new materials used in the operations offer any new exposure potential.

New Employees - The Job Superintendent is responsible for training a new employee in job
expectations, safety rules and procedures, personal protective equipment required on the job and
the Company's Hazard Communication Program. When the later training is completed, the
Superintendent will give the employee a copy of the employee handout on Hazard
Communication then complete the Hazard Communication Training Certificate, and send to the
office to be retained.

ACCIDENT REPORTING AND DISCUSSIONS:

An employee should report any accident or injury, regardless of how minor, to the Job
Superintendent.

All inquiries concerning an incident/accident/injury/property damage should be referred to the

Superintendent. The employee should make no comments, provide no details, or express any
opinion as to the cause of the incident, who was at fault, responsibility for, or any intent of the
company regarding the incident

The Superintendent will investigate any personal injury accident, property damage claim or
vehicle accident associated with the job and will complete an Accident Investigation Report. The
purpose of this investigation is to assist in preventing this type of mishap in the future. The
employee will cooperate fully with the Superintendent in this investigation.

ACCIDENT INVESTIGATION

Every personal injury accident or illness, property damage, and vehicle accident will be

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investigated by the Superintendent or the Supervisor in charge of the operation. The investigation
will be recorded on the ACCIDENT INVESTIGATION REPORT. Every report will be reviewed
by Mr./MS. ????????. Personal injury or illness will be recorded on OSHA Log 200. The
completed Accident Investigation Reports will be review during the monthly Supervisory Safety
Meetings.

PERSONAL PROTECTIVE EQUIPMENT:

Hard Hats All employees are required to wear a hard hat on every job site at all times.

Eye Protection - All employees are required to wear safety glasses on the job site at all times.

Fall Protection All employees exposed to falls over 10ft are required to be trained and use
proper fall protection.

Hand Protection - All employees involved in operations exposing hands to cuts, chemicals,
burns, etc. are required to wear gloves.

Rubber Boots - Employees involved in operations exposing the feet/legs to such hazards as
concrete burns during placing uncured concrete are required to wear rubber boots in good
condition.

Other - Specific jobs may cause the need for other personal protective equipment. When this
occurs, the employee is expected to utilize this equipment. It is the Job Superintendent's
responsibility to see that equipment in use be appropriate and in good condition.

SAFETY RULES AND PROCEDURES:

The safety rules and procedures are developed to assist in achieving job safety by having no
employee accidents. Some of the rules are OSHA requirements. For these reason, every
employee is expected to abide by the safety rules and procedures at all times.

GENERAL:

Employees must follow the safety policy, rules and procedures established by
YOURCOMPANY . Violations may result in disciplinary action, which could include
termination.

Employees should report any equipment or condition considered to be unsafe, as well as what
they consider to be unsafe work practices. This type of information should be reported to the
Superintendent or to the person in charge of the job.

Be courteous. Avoid distracting others as distractions may cause or contribute to accidents. Do

not engage in horseplay on the job.

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When lifting, bend your knees, grasp the load firmly, then raise the load with your legs, keeping
the back as straight as possible. Don't twist body with a load, move your feet. GET HELP for
HEAVY LOADS.

When in doubt about the safety of a situation that is out of the norm, contact the Superintendent
to find the proper procedure.

Good housekeeping practices improves the safety for everyone. When you create clutter, clean it
up. When clutter is left in the work area by someone else, clean it up and report this to the
Superintendent.

The possession or consumption of alcohol, drugs or any control substance is against policy and
violators are subject to dismissal.

SAFETY MEETINGS AND TRAINING

The Job Superintendent is responsible for providing indoctrination and safety training for all new
employees. This training will include: company safety rules and procedures, required personal
protective equipment and the YOURCOMPANY's Hazard Communication Program.
Employees will be provide with a copy of the Safety Rules and Procedures and the employee
handout on the Hazard Communication Program.

Job Site Safety Meetings - The Superintendent will conduct an on-the-job safety meeting each
Monday. The meeting should last no longer than fifteen minutes. Topics for the meetings should
be timely and may include: accidents/injuries/near misses and what needs to be done to prevent
accidents from reoccurring; review of safety rules not being followed; proper use and care of
personal protective equipment; input from employees on how job safety can be improved; new
products/methods being used; safer methods to utilize on the job; and other appropriate topics.
The Superintendent will record the meeting as to topics discussed, date, attendance by obtaining
employee signatures. The original should be sent to the main office with a copy retained with
the job documents. All employees are expected to attend and participate in the weekly job safety
meetings. Areas that concern safety on the job should be brought forward during these meetings

Supervisory Safety Meetings - Top management will plan and arrange for meetings to be held
once each month. Top management and all supervisors will attend and participate in this meeting
to review jobsite accidents, near misses, required training, unsafe conditions/acts noted on safety
inspections, etc.

VEHICLE OPERATIONS:

Employees driving company vehicles, their personal vehicle on company business must have a
current driver's license and an acceptable driving record. Employees driving their personal
vehicle on company business must provide proof of liability insurance to YOURCOMPANY.

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When driving a company vehicle or their personal vehicle on company business, all traffic laws
must be obeyed and driver and any passengers in the front seat must wear a seat belt.

SAFETY INSPECTIONS:

The Job Superintendent will complete an inspection from a safety stand- point at the start of each
new job and on Monday morning of on-going jobs. Areas to check would include, but should not
be limited to, proper tools on the job site to do the job safely, any unusual hazards, such as
stumbling hazards or fall exposure, any overhead objects that could fall on, any special personal
protective equipment needed or special procedures due to job location, areas-operations known
to have contributed to employee accidents in the past, and other items that may be peculiar to the
job or location. The results of each internal inspection will be recorded on the JOB SITE
INSPECTION FORM.

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 YOURCOMPANY HAZARD COMMUNICATION PROGRAM

GENERAL INFOMATION_

In order to comply with 29 OFR 1926.59, Hazard Communication, the following written Hazard
Communication Program has been established by YOURCOMPANY. All work units of the
company are included within this program. The written program will be available in the office,
located at ???????????????????? and through a superintendent for review by any interested
employee. Mr./Ms. ?????????? or the Safety Coordinator is responsible for the implementation
and ongoing compliance with the program.

EMPLOYEE TRAINING ANO INFORMATION

The Job Superintendent is responsible for the employee training program. He will ensure that all
elements specified below are carried out.

Prior to starting work each new employee of YOURCOMPANY will attend a health and safety
orientation and will receive information and training on the following:
- An overview of the requirements contained in the Hazard Communication Standard.
- Chemicals present in their workplace operations
- Location and availability of our written hazard communication program,
-Physical and health effects of the hazardous chemicals.
-Methods and observation techniques used to determine the presence or release of hazardous
chemicals in the work area.
-How to lessen or prevent exposure to these hazardous chemicals through usage of control/work
practices and personal protective equipment.
-Steps YOURCOMPANY has taken to lessen or prevent exposure to these chemicals.
-Emergency procedures to follow if they are exposed to these chemicals.
-How to read labels and review MSDS's to obtain appropriate hazard information.

After attending appropriate training, each employee will sign a form to verify that they received
and understood the training, procedures and policies within YOURCOMPANYHazard
Communication Program

Prior to a new chemical hazard being introduced into any section of this company, each
employee of that section will be given information as outlined above. Mr./Ms. ?????? &/or the
Job Superintendent is responsible for ensuring that MSDS on the new chemicals are available.

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 Written Hazard Communication Program

It is the policy of the YOURCOMPANY, that the first consideration in the performance of work
shall be the protection of the safety and health of all employees. The company has developed this
Hazard Communication Program to ensure that all employees receive adequate information
relevant to the possible hazards that may be involved with the various hazardous substances used
in the company's operations and processes. The following program outlines how we will
accomplish this objective.

SCOPE
This policy covers all potential workplace exposures involving hazardous substances as defined
by federal, state and local regulations.

HAZARD DETERMINATION
The company does not intend to evaluate any of the hazardous substances purchased from
suppliers and/or manufacturers but have chosen to rely upon the evaluation performed by the
suppliers or by the manufacturers of the substances to satisfy the requirements for hazard
determination.

CONTAINER LABELING
No container or hazardous substances will be released for use unless the container is correctly
labeled and the label is legible.
All chemicals in bags, drums, barrels, bottles, boxes, cans, cylinders, reaction vessels, storage
tanks, or the like will be checked by the receiving department to ensure the manufacturer's label
is intact, is legible, and has not been damaged in any manner during shipment. Any containers
found to have damaged labels will be quarantined until a new label has been installed.
The label must contain the chemical name of the contents, the appropriate hazard warnings, and
the name and address of the manufacturer, and any other information required.
All secondary containers shall be labeled. The information must include details of all chemicals
that are in the referenced container.

MATERIAL SAFETY DATA SHEETS (MSDS)

Each location must maintain a master MSDS file as well as a department-specific file. These
Material Safety Data Sheets are available to all employees, at all times, upon request.
The Safety Committee or a designee will be responsible for reviewing all incoming MSDSs for
new and significant health/safety information (the company will ensure that any new information
is passed on to the employees involved).
The Safety Coordinator or designee will review all incoming MSDSs for completeness. If any
MSDS is missing or obviously incomplete, a new MSDS will be requested from the
manufacturer or distributor. OSHA is to be notified if the manufacturer or distributor will not

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supply the MSDS or if it is not received after 30 days from request. Any new information will be
passed on to employees involved.
New materials will not be introduced into the work area until an MSDS has been received.
The purchasing department will make it an ongoing part of its function to obtain MSDSs for all
new materials when they are first ordered.
The safety coordinator or his or her designee shall coordinate with appropriate departments to
make sure all MSDSs are obtained, distributed and communicated.

LIST OF HAZARDOUS SUBSTANCES

Each company should compile, annually review, and update as necessary a complete inventory
of all substances present in that facility. The name of those materials determined to be hazardous
are defined in applicable federal and state standards.

EMPLOYEE INFORMATION AND TRAINING

All employees will attend an orientation meeting for information and training on the following
items prior to starting work with hazardous substances; (Training CHECKLIST is to be
completed and kept on file.)
An overview of the requirements of the Hazard Communication Standard, including their rights
under this regulation.
Information on where hazardous substances are present in their work areas.
Information regarding the use of hazardous sub- stances in their specific work areas.
The location and availability of the written hazard communication program. A copy of the
program will be given to all employees during the orientation meeting. Subsequent to this, the
program will be available from managers and also from the office.
The physical and health aspects of the substances in use.
Methods and observation techniques used to determine the presence or release of hazardous
substances in the work area.
The controls, work practices and personal protective equipment that are available for protection
against possible exposure.
Emergency and first aid procedures to follow if employees are exposed to hazardous substances.
How to read labels and material safety data sheets to obtain the appropriate hazard information.
Refresher training shall be conducted annually.
It is most important that all of our employees understand the information given in the orientation
meetings. Questions regarding this information should be directed to the Safety Coordinator.
When new substances are introduced into the workplace the department manager will review the
above items with you as they are related to the new materials. The department manager will relay
all the above information to new employees who will be working with hazardous substances,
prior to their starting work. An Acknowledgment Statement is to be completed by each employee
receiving this information and training. These are to be kept on file in the human resources
department.

NON-ROUTINE TASKS
Infrequently, employees may be required to perform non-routine tasks that involve the use of

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hazardous substances. Prior to starting work on such projects, each involved employee will be
given information by his or her supervisor about hazards to which they may be exposed during
such an activity.
This information will include:
The specific hazards.
Protective/safety measures that must be utilized.
The measures the company has taken to lessen the hazards, including special ventilation,
respirators, the presence of another employee, air sample readings, and emergency procedures.

PLAN ADMINISTRATION
This Hazard Communication program will be monitored by the Safety Coordinator.
Questions regarding this program should be directed to the Safety Coordinator.
Signature
*Title
Date
*This document must be approved and signed by the senior executive on site.

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 MSDS INFORMATION

OSHA rules outline the content, but not the exact form, of every Material Safety Data Sheet.
Here is what OSHA requires each data sheet to contain:
IDENTITY. The data sheet must contain the name of the chemicals found on the label. In
addition, subject to deletion of legitimate trade secrets, it must give the chemical and common
name of the substance. If the substance is a mixture and has not been tested as such, the data
sheet must give the name of each hazardous constituent.
CHARACTERISTICS. The data sheet must recite the physical and chemical characteristics of
the chemical, such as vapor pressure, flash point, etc.
PHYSICAL HAZARDS. Any potential for fire, explosion or reaction must be included in the
data sheet.
HEALTH HAZARDS. Signs and symptoms of exposure must be entered, as must all medical
conditions that are likely to be aggravated by exposure.
ROUTES OF ENTRY. The data sheet must specify whether the chemical typically enters the
system by ingestion, inhalation, dermal exposure or some other route.
EXPOSURE LIMITS. If OSHA has established an exposure limit for the chemical, or if a
Threshold Limit Value has been established by the American Conference of Governmental
Industrial Hygienists, these must be entered on the data sheet, as must any exposure limit used by
the authority preparing the data sheet.
CARCINOGENS. The data sheet must indicate whether the chemical is listed as a carcinogen
by the National Toxicology Program, by OSHA, or by the International Agency for Research in
Cancer.
USE AND HANDLING. The data sheet must recite any general applicable precautions for safe
handling and use that are known to the firm preparing the data sheet, including hygiene practices,
protective measures during repair and maintenance of contaminated equipment and procedures
for clean-up of spills and leaks. Industrial chemical consumers often might add site-specific
procedures to the more general information offered by the chemical manufacturer.
EXPOSURE CONTROLS. The data sheet must include a description of special procedures to
be employed in emergencies, as well as a description of appropriate first aid.
DATES. The sheet must bear the date of its preparation or of its latest revision.
INFORMATION SOURCE. Finally, the sheet must recite the name, address and telephone
number of the person who prepared the data sheet or of some other person who can provide
additional information relating to the chemical, such as citations to scientific literature or
specialized emergency procedures.

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 MANAGER TRAINING OF EMPLOYEE CHECKLIST

Has the employee been informed of and trained in the following:

1. Information: Has the employee been informed of the following? YES NO

The requirements of this section.

Any operation in the work area where hazardous substances are

present.
The location of the written Hazard Communication Program.

Availability of the written program.

Location and availability of hazardous substances list(s).

Location and availability of Material Safety Data Sheets.

Trai
2. Training: Has the employee been trained in the following?

Methods and observations that may be used to detect the presence

or release of hazardous substances in the work areas.
The physical and health hazards of the substances in the work
areas.
How employees can protect themselves from these hazards.

Procedures the employer has implemented for employee

protection.
Appropriate work practices.

Emergency procedures.

Personal protective equipment to be used.

Explanation of labeling systems.

Explanation of material safety data sheets.

How employees can obtain and use appropriate hazard

information.
Personal hygiene when working with substances.

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 General first aid for contact with hazardous substances.

Employee Signature, Date Manager's Signature, Date

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 REQUEST FOR MATERIAL SAFETY DATA SHEETS

Date of
Request
Department

To

From

I hereby request that I be given the Material Safety Data Sheets on the following hazardous
substance(s):

Date Received
Acknowledge (Requesting Employee)

Department
Manager

Date

cc: Corporate Safety Department

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 PROGRAM/TRAINING DOCUMENT

TRAINING ACKNOWLEDGMENT

I have received information on the Hazard Communication Standard 29 CFR 1910.1200 or the
appropriate state standard and understand how to interpret and to use the labeling systems and
Material Safety Data Sheets (MSDSs) that are in use and accessible to me in my work area. I
agree to observe and follow the safe work practices as presented to me in the training sessions I
attended on at

Employee Signature Date

The above named employee has been informed and instructed by work
practices, chemical hazards recognition, interpretation and use of chemical labels, MSDSs, the
CFR 29, 1910.1200 (e) or appropriate state standard and the location at which these items are
accessible to the employee.

Supervisor Date

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 EXPLANATION OF TERMS USED ON MATERIAL SAFETY DATA SHEETS

SECTION I
Chemical Name and SynonymsThe product identification. The chemical or generic name of
single elements and compounds.
Trade Names and SynonymsThe name under which the product is marketed and the common
commercial name of the product.
Chemical FamilyRefers to a grouping of chemicals that behave and react with other
chemicals in a similar manner.
FormulaThe chemical formula or single elements or compounds.
CAS NumberThe Chemical Abstracts Service number, if applicable.
EPAThe code number assigned by the Environmental Protection Agency, if applicable.
DOT ClassificationThe appropriate classification as determined by the regulations of the
Office of Hazard Material, Department of Transportation.
SECTION II
Hazardous IngredientsThe major components as well as any minor one(s) having potential
for harm that are considered when evaluating the product.
TLVThreshold Limit Value (TLV) indicates the permissible exposure concentration, a limit
established by a government regulatory agency, or an estimate if none has been established.
SECTION III
Physical Data
Boiling Point (F)The temperature in degrees fahrenheit at which the substances will boil.
Vapor PressureThe pressure of saturated vapor above the liquid expressed in mm Hg at 20C.
Vapor DensityThe relative density or weight of a vapor or gas (with no air present) compared
with an equal volume of air at ambient temperature.
Solubility in WaterThe solubility of a material by weight in water at room temperature. The
terms negligible, less than 0.1 percent, 0.1 to 1 percent; moderate 1 to 10 percent, applicable 10
percent or greater.
Appearance and OdorThe general characterization of the material, i.e., powder, colorless
liquid, aromatic odor, etc.
Specific Gravity (H2O=1)The ratio of the weight of a volume of the material to its weight of
an equal volume of water.
Percent, Volatile by Volume (%)The percent by volume of the material that is considered
volatile. (The tendency or ability of a liquid to vaporize.)
Evaporation RateThe ratios of the time required to evaporate a measured volume of a liquid
to the time required to evaporate the same volume of a reference liquid (ethyl ether) under ideal
test conditions. The higher the ratio, the slower the evaporation rate.
SECTION IV
Flash Point (Method Used)The temperature in degrees fahrenheit at which a liquid will give
off enough flammable vapor to ignite in the presence of a source of ignition.
SECTION V
Conditions to AvoidConditions that, if they exist with the substance present, could cause it to
become unstable.
Incompatibility (Materials to Avoid)Materials that will react with the substance.
Hazardous Decomposition ProductsRefers to that reaction that takes place at a rate that

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releases large amounts of energy. Indicates whether or not it may occur and under what storage
conditions.
SECTION VI
Health Hazard DataPossible health hazards as derived from human observation, animal
studies or from the results of studies with similar products.
Threshold Limit Value (TLV)The value for airborne toxic material that are to be used as
guides in the control of health hazards and represent concentrations to which nearly all workers
may be exposed eight hours per day over extended periods of time without adverse effects.
Effects of OverexposureThe effects on or to an individual who has been exposed beyond the
specified limits.
Emergency and First-Aid ProceduresGives first-aid and emergency procedures in case of
eye and/or skin contact, ingestion and inhalation.
SECTION VII
StabilityWhether the substance is stable or unstable, an unstable substance is one that will
vigorously polymerize, decompose, condense, or will become self-reactive under conditions of
shock, pressure, or temperature.
A copy of the form you may want to use to list your hazardous substances by work area follows
this page. This information would be based on the initial survey and subsequent hazard
determination.
SECTION VIII
Spill or Leak ProceduresSteps to be taken if material is released or spilled. Method and
materials to use to clean up or contain.
Waste Disposal MethodMethod and type of disposal site to use.
SECTION IX
Special Protection Information
Respiratory ProtectionSpecific type should be specified, i.e., dust mask, NIOSH-approved
cartridge respirator with organic-vapor cartridge.
VentilationType of ventilation recommended, i.e., local exhaust, mechanical, etc.
Protective GlovesRefers to the glove that should be worn when handling the product, i.e.,
cotton, rubber.
Eye ProtectionRefers to the type of eye protection that is to be worn when handling or around
the product.
Flammable LimitsThe range of gas or vapor concentration (percent by volume in air) that
will burn or explode if an ignition source is present. (Lel) means the lower explosive limits and
(Uel) the upper explosive limits given in percent.
Extinguishing MediaSpecifies the fire-fighting agent(s) that should be used to extinguish
fires.
Special Fire-Fighting Procedures/Unusual Fire and Explosion HazardsRefer to special
procedures required if unusual fire or explosion hazards are involved.

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 WORK AREA HAZARDOUS SUBSTANCE LIST

Work Area:

Chemical Identity
Label/Special Information CAS # or Serial # Vendor

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MATERIAL SAFETY DATA SHEETS

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