TI SLSC Chemical Substance Form

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Description of substance

• Name of substance

• Type of substance

  Solid

  Liquid

  Gas

• Class / Hazchem Number

• Location of substance

• Amount (maximum) held on premises

• Is the substance hazardous to health or the environment? (note which in notes)

  Yes

  No

  N/A

• Is the substance labelled?

  Yes

  No

  N/A

• Add photo of substance

  Media

Control the substance

• What controls are in place to ensure safety of the substance?

• Are the controls effective?

  Yes

  No

  N/A

• If no, complete a hazard report form

Person completing form

• Your name

• Please sign and send to your Supervisor, Safety Advisor or Manager

  Sign

• One copy for HSE manager; one to Area Manager; one to Administration Officer

• Attach copy of the MSDS to this form