A05_HAZMAT Form.pdf

SLD 45 U.S. Space Force PSFB/CCSFS

PAFB/CCAFS Transient Contractor HAZMAT Usage Worksheet Return this form to the Contract/Project Manager (not later than the last business day of each month until term of contract)

Shop Code: Contractor Name: Date of Report: Reporting Period:

Contractor POC for Haz Mat Information Name: Phone: Email:

Contract # Project # Location: Project Start/End Date:

Safety Data Sheet (SDS) Product Trade Name

Part No. Manufacturer Type of Size of Total Qty EESOH MSN (to be added by Container Container Used Base Environmental Office)

1539937967C Typewritten Text

KSCC 18-1525

1539937967C Typewritten Text

KSC

45 SW Construction Contractor Spill Notification Form

Time: Date:

Name and Location of Facility/Building Number:

Name of Individual Making Report:

Contact Phone Number:

Type of Product Spilled: Time of Spill:

Quantity Released: Duration of Release:

Did the Spill Reach Navigable Waters? YES ∆ NO

Cause and Source of Discharge:

Actions Being Taken:

Injuries or Deaths: YES ∆ NO

NOTE: When Reporting the incident using a base telephone line call 911 or using a mobile phone call

(321) 494‐0911 and report to 45 CES/CEIE at (321) 298‐7022.

Contract is Awarded Contractor provides a proposed list of hazardous materials they will be using to the Contracting Officer (CO)

The CO provides this list to the 45CES/CEIE Installation Hazardous Materials Program(IHMP)

Manager

The IHMP will review the proposed list and provide the CO with a list stating which materials will need to be tracked as hazardous materials within 5 working days.

CO relays this information to the contractor

The Contractor will prepare Chemical/Hazardous Material

Request/Authorization Form (Transient Contractor Abbreviated Authorization

Worksheet) for each hazardous material and attach a current manufacturer specific SDS and provide this package to the CO

CO will review the package and submit to the IHMP Manager

IHMP manager will input all data from the Transient Contractor Abbreviated Authorization Worksheet(s) into the Enterprise Environmental

Safety and Occupational Health Management Information System and get authorization from the Hazardous Material Management Process team within ten working days

IHMP Manager informs the CO that the hazardous materials are approved

Contractor is now authorized to use their hazardous materials on base and can begin construction Construction Begins

Contractor provides quarterly purchase reports of all trackable hazardous materials to the CO by the 10th day of the month following each quarter

CO provides quarterly data to the IHMP Manager

IHMP Manager inputs usage data into the

EESOH-MIS

This will continue through the life of the contract

Construction is Completed Contractor provides a final report to reflect any purchases not showing in the last quarterly report to the CO

CO provides the final purchase report to the IHMP Manager and informs them that the contract is complete

IHMP Manager inputs final data and closes out the contract in the EESOH-MIS

Transient Contractor HAZMAT Tracking Process