Attachment B-Safety Data Sheet Request Form.pdf

Attachment B

SAFETY DATA SHEET (SDS) AUTHORING REQUEST FORM

(Prepared by Product Owner – fill in readily available information; all sections do not have to be complete)

Requestor Information

Requested by:

Date:

OU/Division Number:

Why is an SDS being generated?

(New Product, Change to Existing Product’s Formulation, or Change to Existing Product’s Information)

Do you require a container label?

Will the product be shipped internationally? Y/N (specify country if international)1

Requested Delivery Date for the Draft

SDS:

(Standard delivery of a first draft is 10 business days;

rush turnaround of a first draft is 3 business days):

Product Information Product Name/Identifier to appear on SDS (Include ®/™ when appropriate):

Product CAS#, if applicable:

Synonyms (e.g. common names, trade names):

Physical Description (e.g., single crystal, solid bound to substrate, liquid).

Provide picture, optional

Product Use (R&D only?) and intended users:

Name, Address and telephone numbers of the chemical manufacturer, importer, or other responsible party

Other Information:

1 The NIST SDS Authoring Service provides an SDS in English that complies with U.S. Hazard Communication requirements (OSHA 29CFR1910.1200). For products that will be shipped internationally, it is the responsibility of the product importer to ensure that applicable international Hazard Communication requirements (e.g., content, format, language…) of the importing country are met.

SDS Request Form, Page 2 of 4

For mixtures, list all constituent substances and mole/weight percentage or amount

Constituent Substance Names

Substance Synonym or common name

Trade Secret (Yes or No)

Substance

CAS

Number

Substance Concentration (Mole/Weight percentage)

Impurities or additives that may contribute to the product’s hazards

SDS Request Form, Page 3 of 4

Any Available Physical Data for the Product Physical State (solid, liquid, or gas)

Appearance (e.g., color, transparency)

Combustible Dust (Y/N) (Is there the potential for generation of combustible dust?)

Odor and Odor threshold pH

Melting point/freezing point

Initial boiling point and boiling range

Flash point

Evaporation rate

Flammability (solid, gas)

Upper/lower flammability or explosive limits

Vapor pressure and Vapor density

Relative density

Solubility(s)

Partition coefficient: n-octanol/water

Auto-ignition temperature

Decomposition temperature

Viscosity

Chemical Formula and Chemical Formula Weight

SDS Request Form, Page 4 of 4 Any Available Physical Data for the Product (continued)

Miscibility

Fat Solubility

Conductivity

Volatile Organic Compounds (VOCs)

Any Available Stability/Reactivity Information for the Product Reactivity

Explosive

Oxidizing

Chemical stability

Possibility of hazardous reactions

Conditions to avoid (e.g., static discharge, shock, or vibration)

Incompatible materials

Hazardous decomposition products

Any available handling/storage information for the Product Precautions for safe handling

Conditions for safe storage, including any incompatibilities

Accidental Release Measures (Containment/Cleanup/Evacuation):

Is Product considered Hazardous Waste?

Is Product regulated as a Dangerous Good or Controlled Substance?