Safety Indentification 2015

Templates - HAZCOM

239

CUSTOM GHS ORDER FORM

C U S T O M G H S O R D E R F O R M

Key

PRODUCT NAME OR IDENTIFIER

Information contained in the SDS must be used to create the required GHS labels.

(pictograms)

DANGER! (signal word) HAZARD STATEMENT: Describes all applicable dangers of the substance. PRECAUTIONARY STATEMENT: Includes recommended measures to take for prevention, response, storage, disposal, and

Label Requirements: 1 Product name 2 Signal word – DANGER or WARNING 3 Pictogram(s)

4 Hazard statements taken from the SDS for each class and category 5 Precautionary statements contain information about recommended “prevention,” “response,” “storage,” and “disposal” of materials including personal protection equipment and any safe practices for use. 6 Product Manufacturer or Supplier Name, Address, and Telephone Number 7 Supplemental Information as applicable (not required)

Supplemental Information: Other information may also be included

ADDRESS, AND CONTACT INFORMATION OF THE CHEMICAL’S MANUFACTURER OR SUPPLIER

PRODUCTNAME

SIGNAL WORD (check one)

DANGER

WARNING

GHS PICTOGRAMS Hazard Symbols and Classes

CORROSIVE

OXIDIZER

COMPRESSED GAS

POISON

FLAMMABLE

ENVIRONMENTALHAZARD

CHRONIC HEALTH

EXPLOSIVE

ACUTE HEALTH

• Corrosives

• Oxidizers

• Gases Under Pressure

• Acute Toxicity (Severe)

• Flammables • Self-Reactives

• Carcinogen • Respiratory Sensitizer • Reproductive Toxicity • Target Organ Toxicity • Mutagenicity • Aspiration Toxicity

• Explosives • Self-Reactives • Organic Peroxides

• Irritant • Dermal Sensitizer • Acute Toxicity (Harmful) • Narcotic Effects • Respiratory Tract Irritation

• Aquatic Hazard (Acute and Long-Term)

• Pyrophorics • Self-Heating • Emits Flammable Gas • Organic Peroxides

GHS PICTOGRAMS. INPUT LETTER OF ALL THAT APPLY

HAZARD STATEMENT

PRECAUTIONARY STATEMENT

ADDRESS

SUPPLEMENTAL INFORMATION (not required)

tel 800.453.2727 | fax 800.338.0309