007200_Attch7b_Monthly Hazardous Usage Report.pdf
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- Solicitation number
- FA813727R0002
About this file
This is a Monthly Hazardous Material Usage Report template for federal contractors operating on military installations.
The form requires contractors to document monthly chemical usage and storage activities through three main sections. Section 1 captures general information including the contract number, contractor name, report date, on-base point of contact information, emergency contact details, and the physical location of the contractor's field office. Section 2 requests product information such as nomenclature, trade name, part number, manufacturer name and address, and a description of how the product is used. Section 3 requires documentation of usage and storage amounts, with contractors selecting the appropriate unit of measure from options including gallons, units, pints, fluid ounces, pounds, or other specified units. Contractors must record four data points: amount brought on installation, amount used during the reporting period, amount stored, and amount removed. The report must be signed by a responsible contractor representative. The form indicates that additional sheets may be attached if needed to document multiple products or chemicals used during the reporting period.
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Text version
MONTHLY HAZARDOUS MATERIAL USAGE REPORT
REPORT ON CHEMICAL USAGE
1. GENERAL INFORMATION
Contract Number _________________ Contract Performance Period ______________
Contractor's Name ___________________________ Date of Report _______________
Name of On-Base Contractor Point of Contact ________________________________
Phone Number of Contractor On-Base Point of Contact ________________________
Emergency Phone Number _____________________________________________________
Address or Physical Location of the Contractor's Field Office
2. PRODUCT INFORMATION
Product Nomenclature _______________________________________________________
Product Trade Name _________________________________________________________
Product Part Number ________________________________________________________
Manufacturer's Name ________________________________________________________
Manufacturer's Address _____________________________________________________
Physical Locations(s) of On-Base Usage and Storage
_____ Same as Above _____ Other
Description of How Product is used _________________________________________
3. USAGE/STORAGE AMOUNT
Unit of Measure: ______ Gallon(s) ______ Unit(s) ______ Pint(s)
______ Fluid Ounce(s) ______ Pound(s)
______ Other (Specify) _______________________________
Amount Brought Amount Used During Amount Amount on Installation Reporting Period Stored Removed
Signature __________________________________________________________________
(Responsible Contractor)
(Continue on additional sheets if needed)
| Contract Number: |
| Contract Performance Period: |
| Contractors Name: |
| Date of Report: |
| Name of OnBase Contractor Point of Contact: |
| Phone Number of Contractor OnBase Point of Contact: |
| Emergency Phone Number: |
| Address or Physical Location of the Contractors Field Office: |
| Product Nomenclature: |
| Product Trade Name: |
| Product Part Number: |
| Manufacturers Name: |
| Manufacturers Address: |
| Physical Locationss of OnBase Usage and Storage: |
| Same as Above: |
| Other: |
| Description of How Product is used: |
| undefined: |
| Units: |
| Unit of Measure 1: |
| Unit of Measure 2: |
| Unit of Measure 3: |
| Fluid Ounces: |
| Other Specify: |
| on Installation: |
| Reporting Period: |
| Stored: |
| Removed: |
File details come from the government source that posted it. Updated .