Attach 2 - Contractor HAZMAT Usage Report_Mar2015.docx

JBSA Hazardous Material Usage Report JBSA Contractor Hazardous Materials Usage Report Contractor Instructions:

1. List any hazardous material and supporting documentation on the JBSA HAZARDOUS MATERIAL USAGE REPORT (attached) and provide a copy of the manufacturer-specific Safety Data Sheets (SDS) (formerly MSDS) prior to delivery for usage on the project (i.e., before the hazardous material is brought onto the installation).

2. Submit the completed Usage Report attached to the Contracting Officer (CO) Material Approval Form (AF Form 3000). Attach a Compact Disc (CD) with a copy of the Usage Report (formatted in Microsoft Word© or Excel©) and the manufacturer SDSs [formatted in Adobe© Portable Document Format (pdf)].

3. Submit the Usage Report to the CO by the 10th work day of each month. If there is a change or new material is added after the monthly report is submitted, then submit an updated Usage Report (with SDSs) no later than the same work day that the material is received on the installation.

Note: Hazardous Material is described in Federal Acquisition Regulation (FAR) Clause 52.223-3 and Air Force Instruction 32-7086, Hazardous Material Management.

Direct questions to the Contracting Officer.

Contract Number:

Project Name:

Date of Report (Ex: 10Jun 2012):

Reporting Period (Ex: 10Jun2012 -30Jun2012):

Project Address:

Project Building(s) #:

Where will HAZMAT be stored used and stored? Address/Building#:

Contract Start Date:

Contract End Date (Original date):

Modified End Date (If Applicable):

Contractor Business Name: Contractor POC for obtaining HM information:

Phone: Email:

JBSA Contracting Officer Name: Phone #: Email:

JBSA Hazardous Material Inventory & Monthly Usage Report

Ref # Process (Brief description of the work being performed.)

(e.g., drum, glass bottle, aerosol can, tube)

EESOH MSN (to be added by JBSA HAZMAT MGR)

Locally generated form – Joint Base San Antonio-Fort Sam Houston Locally generated form – Joint Base San Antonio-Fort Sam Houston