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					                                                                                         THE COLLEGE AT BROCKPORT
                                                                                     ENVIRONMENTAL HEALTH AND SAFETY
                                                                                          Chemical Inventory Form for 20___
                                                                              Emergency Notification Information (Required by NYS/Federal Law)
 Emergency Contact Name:                                                                                                       Phone:
 After Hours Contact Name (if different than above):                                                                           Phone:
 Facility/Department Name:                                                                                                     Phone:
 Contact Name (person filling out form):                                                                                       Phone:
 Building Name:                                                                                                                Inventory Date:
 Room Number of Chemical Storage (Please submit separate sheet for each room):   If additional sheets are attached XXX here:
                            NO Chemicals Stored in this location: __________   INITIAL Inventory ONLY: __________            Inventory UPDATE ONLY: __________
                                                                                                                                                                 Physical State     Size of       Number of        Total Quantity (G,lb,oz)
                           Chemical Name as listed on container                                     Manufacturer (not Distributor or Supplier)
                                                                                                                                                                  (S, L or G)      Container      Containers             See key below
 1
 2
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                                                                                                          CHEMICAL DATA KEY
                      Quantity (maximum quantity in storage at any one time): L= liter ml= milliliter g= gram kg = kilogram oz = ounce p = pint q = quart G = gallon lb = pound drum - indicate drum size (i.e. 55G)
                                                                                             Physical State: S = Solid     L = Liquid    G = Gas

  A *MATERIAL SAFETY DATA SHEETS (MSDS) for every chemical must be available to all employees in their work area. Manufacturers are responsible by law to provide a MSDS on request. You should call or contact the manufacturer/supplier if a
                             MSDS is not provided for a chemical. If you have any questions or problems obtaining an MSDS, please contact Sarah Klein at 395-2495 in Environmental Health and Safety.


C:\Docstoc\Working\pdf\5b1eeac2-bf25-4577-9b58-c7fcee312241.xlsx 11/25/2011
Building Name:                                                                                                                                               Inventory Date:
Room Number of Chemical Storage (Please submit separate sheet for each room):

                               NO Chemicals Stored in this location: __________                   INITIAL Inventory ONLY: __________                      Inventory UPDATE ONLY: __________

                                                                                                                                                               Physical State     Size of       Number of        Total Quantity (G,lb,oz)
                    Chemical Name as listed on container                                          Manufacturer (not Distributor or Supplier)
                                                                                                                                                                (S, L or G)      Container      Containers             See key below
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
                                                                                                        CHEMICAL DATA KEY
                Quantity (maximum quantity in storage at any one time): L= liter ml= milliliter g= gram kg = kilogram oz = ounce p = pint q = quart G = gallon lb = pound drum - indicate drum size (i.e. 55G)
                                                                                           Physical State: S = Solid     L = Liquid    G = Gas

A *MATERIAL SAFETY DATA SHEETS (MSDS) for every chemical must be available to all employees in their work area. Manufacturers are responsible by law to provide a MSDS on request. You should call or contact the manufacturer/supplier if a
                           MSDS is not provided for a chemical. If you have any questions or problems obtaining an MSDS, please contact Sarah Klein at 395-2495 in Environmental Health and Safety.

				
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