San Juan College
Notification
of the Usage of
Acutely Toxic, Carcinogenic, or Reproductive Hazards
Please
complete this form and return it to the Office of Health &
Safety.
Lab Supervisor/Lead Instructor:
Room/Building:
Phone:
Department/Program:
Notification: In
accordance with the requirements of the
Chemical Hygiene Plan,
this document serves as notification to Health & Safety of the
use of the following class(es) of chemicals:
|
|
Used |
Not Used |
| Carcinogens or suspected carcinogens |
|
|
| Acutely
toxic chemicals |
|
|
| Reproductive
hazards |
|
Statement of compliance
I have reviewed the requirements of the
College’s Chemical Hygiene Plan
and the applicable Standard Operating Procedures as they apply to
carcinogens, acutely toxic chemicals, and reproductive hazards, and
have complied with all applicable requirements, to the best of my
knowledge and to the extent feasible.
| Signature: | Date: |