Attachment 0005 - DD FORM 2357 - Hazardous Component Safety Data Sheet.pdf

HAZARDOUS COMPONENT SAFETY DATA STATEMENT

(HCSDS)

1. DATE PREPARED

(YYYYMMDD)

REPORT CONTROL SYMBOL

2. MATERIAL/COMPONENT/ASSEMBLY 3. NUMBER 4. REVISION

5. APPLICABLE FEDERAL ACQUISITION REGULATION (FAR) SAFETY CLAUSE

PART I - SENSITIVITY (Apparatus and Comparison Values)

6. FRICTION TEST 7. IMPACT TEST 8. ELECTROSTATIC DISCHARGE TEST

PART I - HAZARDS

9. FIRE 10. AUTO IGNITION TEMP. 11. FLASH POINT 12. DECOMPOSITION PRODUCTS

13. FLAMMABLE AND/OR EXPLOSIVE LIMITS 14. EXPLOSION 15. EXPLOSIVE TEMP.

(5 Sec.)

16. DUSTS

a. LOWER PERCENT b. UPPER PERCENT

17. HEALTH HAZARD INFORMATION (Toxicity) 18. UNPACKED (In-Process) HAZARD CLASS (Specify quantities involved)

19. SPECIAL REQUIREMENTS (If additional space is needed, use plain bond paper)

PART III - SHIPPING/STORAGE CLASSIFICATION OF ITEM WHEN PACKED

IN ACCORDANCE WITH APPROVED PACKING DRAWINGS

20. DOD HAZARD CLASS/DIV 21. DOD STORAGE COMPATIBILITY

GROUP

22. DOT HAZARD CLASSIFICATION 23. DOT CONTAINER MARKING

24. PREPARED BY (Initiator)

a. TYPED OR PRINTED NAME b. SIGNATURE c. ORGANIZATION

25. CONCURRED IN BY

a. TYPED OR PRINTED NAME b. SIGNATURE c. ORGANIZATION

26. SAFETY CHIEF OR AUTHORIZED REPRESENTATIVE

a. TYPED OR PRINTED NAME b. SIGNATURE c. ORGANIZATION

The information relating to safety (herein referred to as "safety data") contained in this document is limited to those instances when the document is provided as a part of a procurement/production package which involves the development, testing, storage, manufacture, modification, renovation, demilitarization, packaging, transportation, handling, disposal, inspection, repair or any other use of the item (material/component/assembly) which is specified in the contract. The safety data contained herein are examples which shall be used by the contractor to alert contractor personnel as well as other personnel of hazards associated with the procurement/production of the item. No representation is made that compliance with the information provided will prevent any accident to persons or property or that additional warnings may not be appropriate. Neither the foregoing nor any act or failure to act by the Government in regard to alerting personnel to the hazards of the item shall affect or relieve the contractor of responsibility for the safety of contractor personnel or property and for the safety of the general public in connection with the performance of the contract, or impose or add to any liability of the Government for such safety.

DD FORM 2357, APR 1999 PREVIOUS EDITION MAY BE USED. WHS/DIOR, Apr 99