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2. New Chemical/SDS Request

   Since the department understands its operational needs and is independent in ordering supplies including chemicals, the Haz Comm Program Manager/Coordinator will collaborate with the Department Manager and/or designee to ensure that the City is in compliance with its Hazard Communication Program. To accomplish this, please complete this form once it is determined that a new chemical will be acquired.

4. Department*
6. Form completed by:*
8. Date Submitted:
   Date Submitted:
12. Chemical Name:*
14. Potential Exposures:*
16. Additional Information:

    Include any information such as required equipment, supplies, and permits associated with using the chemical.

18. SDS Upload

    You may upload a copy of the SDS for review.

20. Comments:
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field