The Emergency Response Safety and Health Database Lung Damaging

Emergency Response Card Template Prepared by _________ (Agency) Date______ AGENT :: Health Effect Category CAS #: RTECS #: Common Names: Agent Characteristics    APPEARANCE: DESCRIPTION: (overview) METHODS OF DISSEMINATION: o Indoor Air: o Water: o Food: o Outdoor Air: o Agricultural: ROUTES OF EXPOSURE:          Personal Protective Equipment CLOTHING: EYE PROTECTION: GLOVES: RESPIRATOR: Emergency Response CHEMICAL DANGERS: EXPLOSION HAZARDS: FIRE FIGHTING INFORMATION: INITIAL ISOLATION AND PROTECTIVE ACTION DISTANCES: o Small spills, when used as a weapon: o Large spills, when used as a weapon: o Small spills: (initial and day vs. night distances) o Large spills: (initial and day vs. night distances) PHYSICAL DANGERS: NFPA 704 Signal: SAMPLING AND ANALYSIS:            Signs/Symptoms TIME COURSE: EFFECTS OF SHORT-TERM EXPOSURE: EYE EXPOSURE: INGESTION EXPOSURE: INHALATION EXPOSURE: SKIN EXPOSURE: Decontamination (Human) FIRST RESPONDER: PATIENT: o Guidance for First Responders: o Procedures for patient decontamination: First Aid  GENERAL INFORMATION: Model template prepared by NIOSH (7-13-2004)                ANTIDOTE: EYE: INGESTION: INHALATION: SKIN: Long-Term Implications MEDICAL TREATMENT: EFFECTS OF LONG TERM OR REPEATED EXPOSURE: On-Site Fatalities INCIDENT SITE: RECOVERY AND ON-SITE MORGUE: Occupational Exposure Limits NIOSH REL: OSHA PEL: ACGIH TLV: NIOSH IDLH: DOE TEEL: AIHA ERPG: NAS Acute Exposure Guidelines (AEGLs) Decontamination (Environment and Equipment)   ENVIRONMENT/SPILLAGE DISPOSAL: EQUIPMENT: Agent Properties Chemical Formula Aqueous solubility Boiling Point Density Flammability Flashpoint Ionization potential Log Kbenzene-water Log Kow (estimated) Melting Point Molecular Mass Soluble In Specific Gravity Vapor Pressure Volatility Packaging and Labeling UN # Proper Shipping Name DOT Hazard Class DOT Label DOT Marking Model template prepared by NIOSH (7-13-2004) DOT Placard Trade Names and Other Synonyms Who to Contact in an Emergency For information on who to contact in an emergency, see the CDC website at http://www.bt.cdc.gov/emcontact/index.asp or call the CDC public response hotline at (888) 246-2675 (English), (888) 246-2857 (Español), or (866) 874-2646 (TTY). Important Notice The user should verify compliance of the cards with the relevant STATE or TERRITORY legislation before use. NIOSH, CDC 2003. Example References Sources (Cite references actually used): 1. 2000 Emergency Response Guidebook http://hazmat.dot.gov/gydebook.htm 2. Agency for Toxic Substances and Disease Registry: Medical Management Guidelines www.atsdr.cdc.gov/mmg.html 3. Agency for Toxic Substances and Disease Registry: ToxFaqs www.atsdr.cdc.gov/toxfaq.html 4. Agency for Toxic Substances and Disease Registry: Toxicological Profile Information Sheet www.atsdr.cdc.gov/toxpro2.html 5. Center for Disease Control: Chemical Agents http://www.bt.cdc.gov/agent/ 6. Chemical Hazards Response Information System http://www.chrismanual.com/ 7. ChemIDplus, National Library of Medicine http://chem.sis.nlm.nih.gov/chemidplus 8. Computer-Aided Management of Emergency Operations (CAMEO): http://www.epa.gov/ceppo/cameo/ 9. EMedicine.com http://www.emedicine.com/ 10. International Occupational Safety and Health Information Centre (CIS): International Chemical Safety Cards (ICSCs) http://www.ilo.org/public/english/protection/safework/cis/prod ucts/icsc/ 11. IPCS INCHEM http://www.inchem.org/ 12. National Institute for Occupational Safety and Health: Emergency Response Cards http://www.bt.cdc.gov/agent/index.asp 13. National Institute for Occupational Safety and Health: Pocket Guide http://www.cdc.gov/niosh/npg/npg.html 14. National Institute for Occupational Safety and Health: Chemical Safety http://www.cdc.gov/niosh/topics/chemicalsafety/default.html 15. National Library of Medicine: HSDB/TOXNET http://toxnet.nlm.nih.gov 16. The Merck Index, 13th Edition http://products.camsoft.com/themerckindex.cfm Model template prepared by NIOSH (7-13-2004) 17. US Department of Energy: Emergency Response Planning Guidelines (ERPGs) and Temporary Emergency Exposure Limits (TEELs) http://www.eh.doe.gov/chem_safety//teel.html 18. US EPA Acute Exposure Guideline Levels http://www.epa.gov/oppt/aegl/chemlist.htm 19. US Army Center for Health Promotion & Prevention Medicine: Chemical Warfare Agents http://chppmwww.apgea.army.mil/hrarcp/CAW/ 20. United States Fire Administration: Hazardous Materials Guide http://www.usfa.fema.gov/fireservice/hazmat/hazmatguide/hmgfr3.shtm Model template prepared by NIOSH (7-13-2004)