Title Page

  • Client / Site

  • Conducted on

  • Prepared by

  • Location

General Information

  • Description of work to be performed

Chemical Hazards Discussions

  • Overexposure to chemical substances may cause acute or chronic health damages. Before commencing work read chemical labels and follow instructions carefully. Always remember to wear appropriate Personal Protective Equipment (PPE) and as much as possible minimize your exposure to a chemical substance while conducting work. Keep working area clean and do not return contaminated or unused material to its original container.

    Below are pictogram labels to alert users of the chemical hazards:


Follow up questions

  • Is there anyone suffering from health symptoms?

  • List down the symptoms encountered.

  • Is there any hazard happened during the shift?

  • What are those hazards?

  • Any question or comment about these pictures used to describe chemical hazards?

  • What are the questions needs to clarify?


  • Recommendations


  • Competent Person (Full Name and Signature)

  • By signing this, you confirm that the information discussed during this meeting were fully understood.

  • Click + to add signee

  • Employee
  • Employee (Full name and signature)

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.