Title Page
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Client / Site
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Conducted on
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Prepared by
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Location
General Information
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Description of work to be performed
Chemical Hazards Discussions
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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
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Is there anyone suffering from health symptoms?
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List down the symptoms encountered.
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Is there any hazard happened during the shift?
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What are those hazards?
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Any question or comment about these pictures used to describe chemical hazards?
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What are the questions needs to clarify?
Recommendations
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Recommendations
Completion
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Competent Person (Full Name and Signature)
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By signing this, you confirm that the information discussed during this meeting were fully understood.
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Click + to add signee
Employee
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Employee (Full name and signature)