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Saf et y Meet i ng Mi nut es
Use wi th WAC 296- 800- 130 Safety Commi ttees and Safety Meeti ngs
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Sampl e Hazardous Chemi cal
Communi cat i on Program
A. Company Policy
(N am e of em ployer)
is com m itted to the prevention of exposures that result in injury
and/or illness; and to com ply w ith all applicable state health and safety rules. To m ake
sure that all affected em ployees know about inform ation concerning the dangers
of all hazardous chem icals used by
(N am e of em ployer)
, the follow ing hazardous
inform ation program has been established.
A ll w ork units of
(N am e of em ployer)
w ill participate in the hazard com m unication
program . This w ritten program w ill be available in
(Specify the location)
for review by any
interested em ployee.
B. Container Labeling
(N am e of person and position)
is responsible for container labeling procedures, review ing, and
updating. The labeling system used at
(N am e of em ployer)
is as follow s:
(Descri be the l abel i ng system, i ncl udi ng the l abel s or other forms of warni ng used, and wri tten al ternati ves to l abel i ng, i f any.)
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
The procedures for proper labeling of all containers, and review ing and updating label
w arnings are as follow s:
(Al so i ncl ude a descri pti on of the procedures for l abel i ng of secondary contai ners used, i ncl udi ng maki ng sure that they have the appropri ate
i denti fi cati on and hazard warni ng, etc.; descri pti on of procedures for revi ewi ng and updati ng l abel warni ngs, how often the revi ew i s conducted,
and the name of the person and posi ti on who i s responsi bl e for revi ewi ng and updati ng l abel warni ngs.)
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
It is the policy of
(N am e of em ployer)
that no container w ill be released for use until
the above procedures are follow ed.
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Communi cat i on Program
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Sampl e Hazardous Chemi cal
Communi cat i on Program
C. Material Safety Data Sheets (MSDS)
(N am e of person and position)
is responsible to establish and m onitor the em ployer’s M SD S
program . This person w ill m ake sure procedures are developed to obtain the
necessary M SD Ss and w ill review incom ing M SD Ss for new or significant health and
safety inform ation. This person w ill see that any new inform ation is passed on to
affected em ployees.
The procedures to obtain M SD Ss and review incom ing M SD Ss for new or significant
health and safety inform ation are as follow s:
(Incl ude procedures on how to make sure copi es are current and updated, how any new i nformati on i s passed on to affected empl oyees, and the
procedures for empl oyee access i n work areas.)
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
C opies of M SD Ss for all hazardous chem icals in use w ill be kept in
(Specify the location)
M SD Ss w ill be available to all em ployees during each w ork shift. If an M SD S is not
available or a new chem ical in use does not have an M SD S, im m ediately contact
(The person and position)
.
Note:
If an alternative to printed M aterial Safety D ata Sheets is used (such as
com puter data), provide a description of the form at.
D. Employee Information and Training
(N am e of person and position)
is responsible for the em ployer/em ployee training program .
The procedures for how em ployees w ill be inform ed and trained are as follow s:
(Incl ude the methods used for general and si te- speci fi c trai ni ng, and how empl oyees wi l l be i nformed when non- routi ne tasks ari se. If your
empl oyees work at other empl oyers’ j ob si tes, then speci fy where and how these empl oyees wi l l have access to MSDSs and l abel s, and how they
wi l l be i nformed of precauti onary measures to take duri ng normal or emergency operati ons, i f any.)
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
(N am e of person and position)
w ill m ake sure that before starting w ork, each new
em ployee of
(N am e of em ployer)
w ill attend a health and safety orientation that
includes inform ation and training on the follow ing:
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Communi cat i on Program
• A n overview of the requirem ents contained in the H azard C om m unication
Standard.
• H azardous chem icals present at his or her w ork places.
• Physical and health risks of the hazardous chem ical.
• The sym ptom s of overexposure.
• H ow to determ ine the presence or release of hazardous chem icals in his or her
w ork area.
• H ow to reduce or prevent exposure to hazardous chem icals through use of
control procedures, w ork practices, and personal protective equipm ent.
• Steps the em ployer has taken to reduce or prevent exposure to hazardous
chem icals.
• Procedures to follow if em ployees are overexposed to hazardous chem icals.
• H ow to read labels and review M SD Ss to obtain hazard inform ation.
• Location of the M SD S file and w ritten hazard com m unication program .
B efore introducing a new chem ical hazard into any section of this em ployer, each
em ployee in that section w ill be given inform ation and training as outlined above for
the new chem ical.
E. Hazardous non-routine tasks
Periodically, em ployees are required to perform hazardous non-routine tasks. (Som e
exam ples of non-routine tasks are confined space entry, tank cleaning, and painting
reactor vessels.) N on-routine tasks that are perform ed at
(N am e of em ployer)
include
1.___________________________________________________________________________
2.___________________________________________________________________________
3.___________________________________________________________________________
Prior to starting w ork on such projects, each affected em ployee w ill be given
inform ation by
(N am e of person and position)
about the hazardous chem icals he or
she m ay encounter during these activities:
(For each acti vi ty, l i st the speci fi c chemi cal hazards, protecti ve and safety measures the empl oyee can use, and the steps the empl oyer has taken to
reduce the hazards, i ncl udi ng venti l ati on, respi rators, presence of another empl oyee, and emergency procedures.)
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
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Communi cat i on Program
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Sampl e Hazardous Chemi cal
Communi cat i on Program
F. Multi employer work places
It is the responsibility of
(N am e of person and position)
to provide em ployers of any other
em ployees at the w ork site w ith the follow ing inform ation:
• C opies of M SD Ss (or m ake them available at a central location) for any
hazardous chem icals that the other em ployer(s)’em ployee m ay be exposed to
w hile w orking.
• Inform other em ployers of any precautionary m easures that need to be
taken to protect em ployees during norm al operating conditions or in
foreseeable em ergencies.
• Provide other em ployers w ith an explanation of the labeling system that is used
at the w ork site.
It is also the responsibility of
(N am e of person and position)
to identify and obtain M SD Ss for
the chem icals the contractor is bringing into the w ork place.
G. List of hazardous chemicals
The follow ing is a list of all know n hazardous chem icals used by our em ployees.
Further inform ation on each chem ical m ay be obtained by review ing M SD Ss located at
(Specify the location)
.
MSDS identity:
(H ere is w here you put the chem ical list developed during the inventory. A rrange this
list so that you are able to cross-reference it w ith your M SD S file and the labels on your
containers.)
The criteria (e.g., label w arnings, M SD S inform ation, etc.) used to evaluate the
chem icals are:
(Incl ude a descri pti on of a pl an for how you wi l l update the l i st.)
Chemical Name Manufacturer Location Used
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
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Communi cat i on Program
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Sampl e Hazardous Chemi cal
Communi cat i on Program
The sam ple labels on the follow ing page show the type of inform ation you m ust list on
containers of hazardous chem icals. You can copy and use these labels or you can
m ake your ow n.
B e sure your labels contain the follow ing inform ation:
• N am e of C hem ical
• Physical H azards
• H ealth H azards, Target O rgans or System s
• O ptional inform ation, such as Personal Protective Equipm ent or Safe H andling
A fter you’ve finished typing or w riting in your inform ation, print the labels. Then, cut out
the individual labels and apply them to your hazardous chem ical containers.
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Sampl e Label s f or
Hazardous Chemi cal Cont ai ners
Use wi th WAC 296- 800- 170 Empl oyer Chemi cal Hazard Communi cati on
1 • 8 0 0 • 4 B E S A F E ( 1 • 8 0 0 • 4 2 3 • 7 2 3 3 )
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h t t p : / / w w w . l n i . w a . g o v /
11/03
Sampl e Label s f or
Hazardous Chemi cal Cont ai ners
Use wi th WAC 296- 800- 170 Empl oyer Chemi cal Hazard Communi cati on
______________________________________ ______________________________________
Name of Chemical or Common Name Name of Chemical or Common Name
__________________________________ __________________________________
Physical Hazards Physical Hazards
__________________________________ __________________________________
Health Hazards, Target Organs or Systems Health Hazards, Target Organs or Systems
__________________________________ __________________________________
Optional Information, such as Personal Optional Information, such as Personal
Protective Equipment or Safe Handling Protective Equipment or Safe Handling
__________________________________ __________________________________
Name of Chemical or Common Name Name of Chemical or Common Name
__________________________________ __________________________________
Physical Hazards Physical Hazards
__________________________________ __________________________________
Health Hazards, Target Organs or Systems Health Hazards, Target Organs or Systems
__________________________________ __________________________________
Optional Information, such as Personal Optional Information, such as Personal
Protective Equipment or Safe Handling Protective Equipment or Safe Handling
__________________________________ __________________________________
Name of Chemical or Common Name Name of Chemical or Common Name
__________________________________ __________________________________
Physical Hazards Physical Hazards
__________________________________ __________________________________
Health Hazards, Target Organs or Systems Health Hazards, Target Organs or Systems
__________________________________ __________________________________
Optional Information, such as Personal Optional Information, such as Personal
Protective Equipment or Safe Handling Protective Equipment or Safe Handling
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