ENGD New Chemical Review Form
Fill out sections 1 through 4 completely and attach a Safety Data Sheet (SDS) to this form. If the answer to any of the questions in section 3 is yes, the chemical must be reviewed by the ENGD Safety Committee before it is purchased or otherwise brought into the building. If the answer to all questions in Section 3 is no, then the chemical may be purchased once this form has been completed and given to the ENGD Chemical Safety Officer.
Section 1: Basic Information
Chemical Name:Click here to enter text.
Manufacturer:Click here to enter text.
Section 2: Acquisition Information
a)Is there a safer chemical appropriate for this application?
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b)Is the chemical already available on campus (e.g. from the Chemistry stock room)?
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c)What is the amount that is needed?
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d)What is the minimum amount that can be ordered?
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Section 3: Hazard Review(see back of form for definitions.)
a)Is the chemical a carcinogen?
b)Is the chemical highly toxic?
c)Is the chemical a nanomaterial?
d)Is the chemical an explosive?
e)Is the chemical a poison gas or a pyrophoric?
f)Does the chemical have a rating of 1 or 2 in any GHS category?
☐Y☐N
☐Y☐N
☐Y☐N
☐Y☐N
☐Y☐N
Section 4: Storage, Use, and Disposal Information
a)Beyond what was noted in Section 3, what risks does the chemical introduce? (e.g. Does this chemical become unstable after a short period of time?)
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b)Are there additional controls needed for this chemical? (e.g. personal protective equipment beyond lab minimums, special training, etc.)
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c)What will be the procedure for using this chemical, and how will users be trained?
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d)Are there unique storage requirements? And if so, is the necessary equipment to meet those requirements in place? (e.g. refrigeration, security, etc.)
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e)In case of emergency (e.g. spill, fire, etc.) what is(are) the recommended action(s) to take for this particular chemical?
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f)Will there be problems with disposal?
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g)When will the project be completed/when will the chemical no longer be needed?
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Definitions for Section 3:
a)A carcinogen is a substance that meets one of the following criteria:
(a)It is listed under Group 1 (“carcinogenic to humans”) or Group 2A (“probably carcinogenic to humans”) by the International Agency for Research on Cancer Monographs (IARC) or
(b)It is listed under the category, “Known to be Human Carcinogens” in the Annual Report on Carcinogens published by the National Toxicology Program (NTP) (See Appendix I)
b)Chemical agents that are classified as highly toxic are substances which have a high degree of acute toxicity. OSHA (29 CFR 1910.1200)
Such agents meet the following criteria:
(a)Chemical has a median lethal dose (LD50) of 50 milligrams or less when administered orally to rats [LD50 < 50 mg/kg]; or
(b)Chemical has a median lethal dose (LD50) of 200 milligrams or less when administered by continuous dermal contact for 24 hours (or less if death occurs within 24 hours) to the skin of rabbits [LD50 < 200 mg/kg]; or
(c)Chemical has a median lethal concentration (LC50) in air of 200 parts per million by volume when administered by continuous inhalation for one hour (or less if death occurs within one hour) to rats [LC50 < 200 ppm]
c)Nanomaterial is classified as material that has been purposefullymanufactured, synthesized, or manipulated to have a size with at least one dimension in the range of approximately 1 to 100 nanometers and exhibit unique properties determined by their size as defined by the Occupational Health and Safety Administration (OSHA)
d)An explosive is defined as “any chemical compound, mixture, or device which is designed to function by explosion that is substantially instantaneous with the release of gas and heat” by the U.S. Department of Transportation. Explosives are regulated by the Bureau of Alcohol, Tobacco, Firearms, and Explosives, ATF (27 CFR 555.23)
Such agents meet the following criteria:
(a)Contain chemical functional groups that are known to be explosive
(b)Involves incompatibles that could potentially lead to the formation of chemical functional groups known to be explosive
(c)Involves a pure substance or mixture containing peroxides, peroxide formers, or other strong oxidizers (see Appendix II)
e)A poison gas is defined as gases that are known to be poisonous by inhalation listed under Class 2.3 of US Department of Transportation Hazardous Materials Table. DOT (49 CFR 173.115) (See Appendix III)
A pyrophoric substance is “a chemical which, even in small quantities, is liable to ignite within five minutes after coming into contact with air” as defined by OSHA (29 CFR 1910.1200) (See Appendix IV)
f)
GHS Rating SystemRating / Hazard Level
1 / Severe
2 / Serious
3 / Moderate
4 / Slight
(See Appendix V for more specific definitions)