CONCO AERO MAINTENANCE PTE LTD

HAZARDOUS SUBSTANCE / CHEMICAL ASSESSMENT SHEET

Assessment to be completed by Assessor (HOD-in-charge)

Department:
Assessors Name:

Contact No.:

(Staff- in- charge)

Product Name: (State
Synonyms, if any)

Suppliers Name:
Product Used For:

Contact No.:

(State purpose)

() Tick where applicable.

Combustible
Explosive

Carcinogenic

Organic Peroxide

Lung Toxin

Irritant

Compressed Gas

Reproductive
Toxin

Flammable
Sensitizer
Nervous System
Pyrophoric
Toxic
Blood Toxin
Reactive
Combustible Liquid
Kidney Toxin
Corrosive
Oxidizer
Liver Toxin
Physical Features
Solid
Liquid
Gas
NFPA Rating
___ Fire
___ Health
___ Reactivity
Implementation precautionary measures. To Refer to Safety Data Sheet (SDS)
Storage Type &
Tank
Steel Drum
Carboy
Location:Tank Wagon
Plastic Drum
Box
Tote Bin
Fiber Drum
Bag
Silo
Steel Can
Glass Bottle
Fire Extinguisher
Water
Dry Powder
Foam
Disposal
Client
Contractor
Supplier

Eye hazard

Product Hazard

Skin Dermatitis

Others:Powder
___ Special
Cylinder
Others:CO2
Recyclable

Spillage
Environmental
Dust Mask

Personal
Protective
Equipment

Cartridge
Respirator

S.C.B.A.

PVC / Nitrile Glove

Leather Glove

Leather Apron

Neoprene Glove

Chemical Suit

Face Shield

Rubber Glove

Chemical Apron

Goggles

Special Protection
(if any)

Routes of Entry

Effects of Exposure

First Aid Measures

(1) Skin
(2) Inhalation
(3) Ingestion
Special Handling
procedures
Health Hazard
Review &
Accepted by:

Date:

(HSE Personnel

(Name & Signature)

(1)

* Denotes Delete where applicable;

(2)

To attach Safety Data Sheet (SDS) with Hazardous Substance Chemical Assessment (HSCA) Form.

Originator: Eswaren

HS_Rev.00 Hazardous Substance / Chemical Assessment Form

Approval: S.Devanathan
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CONCO AERO MAINTENANCE PTE LTD

TRAINING ON THE USE OF PRODUCT (CHEMICAL)

Product Name: (State
Synonyms, if any)

Location of Usage:
(to state location)

Conducted by:

(Name & Signature)

(HOD- in- charge)

Date:

The following precautionary measures were communicated during the briefing.

(1) The safe use, storage and handling of the hazardous materials.
(2) The nature and hazards of the hazardous materials.
(3) The personal protective equipment required for the handling of hazardous materials
(4) The first aid measures applied when come into contact with the hazardous materials.
(5) The spill response and clean up procedures.
I / we,* confirmed that we have read and understand the hazards of the material that I / we * are using and
will abide by the safety precautions and measures.
S/N

Originator: Eswaren

Name

Designation

HS_Rev.00 Hazardous Substance / Chemical Assessment Form

Company

Signature

Approval: S.Devanathan
Page 2 of 2