Chemical Inventory Form
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1
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3Joel Klein
Chancell
Chemical Inventory Form
Instructions
Please be aware that for purposes of this inventory, the term chemical refers to any liquid, gas or
solid used in the school or facility (e.g., rubber cement or duplicating fluid), as well as items used
in science, vocational or trade shops. The Chemical Inventory form must be updated on an
annual basis. The Chemical Inventory must be completed for each room, collected, and stored in
a file on site.
A. Each room in your facility must be surveyed.
This includes annexes, basements and
storage closets. Use a new form for each room.
B. List all chemical substances found in the room.
Do not list articles such as furniture,
machinery, or equipment. If you are not sure whether a substance should be included, list it
anyway. If there are too many chemicals in the room to fit on one sheet, use additional
sheets and number each successive sheet.
C. If there are no chemicals in a room, prepare a form for that room with “No Chemicals” written
in the body.
D. Please make sure that the heading on the form is carefully filled out. Enter your name and
telephone number on the form, so that if there is a question about an entry you may be
contacted.
E. Enter “N/A” in spaces where information is not available. Do not leave any space blank.
F. Please print all information clearly.
Definitions
Item 1 – Product Trade Name
Speedball Textile Ink”). Use codes listed on
the inventory sheet.
Enter the name as it is listed on the product
label (e.g., “Red Devil Paint” or “Phenol”).
Item 7 – Quantity
Item 2 – Manufacturer’s Name, Address
Number of containers (e.g., 50 bottles, 13
cans, 6 boxes).
and Telephone Number
This information is found on the label. If
Item 8 – Container Type
there is a telephone number, please list this
Use code listed at the bottom of the
also.
inventory sheet.
Item 3 – Exact Storage Location
Item 9 – Units of Measure
By law, storage location must be precise.
Use code listed on the bottom of the
State exactly where in the room the product
inventory sheet to describe the size or
is stored (e.g., “under copy machine; third
volume of the container (e.g., 6 oz, 1 G). If
closet from the window”).
units of measure are metric, use the metric
measure. It is not necessary to convert.
Item 4 – Warnings on Label
State the immediate health hazard listed on
Item 10 - # of Employees Exposed
the label (e.g., “eye irritation, flammable,
Enter the number of employees who handle
skin burns”). If there are no warnings on the
the substance or who may be routinely
label, write “No Warnings Indicated”.
exposed to the substance.
Item 5 –Other Identifying Information
Item 12 – MSDS
Use this column to describe the product if it
Material Safety Data Sheets (MSDS) are
does not have a label (e.g., “floor cleaner;
supplied by the manufacturer of the
white powder in can; liquid in brown bottle”).
chemical substance. Place a check {√} in
If the label has a CAS number (Chemical
this box if a MSDS is on file in your school.
Abstracts Service) please writes this number
If you do not know whether your school has
in the space provided. If one does not exist,
a MSDS for a particular product, enter
write “None” in the space provided.
“N/A” in this box.
Item 6 – Physical State
Each chemical will be either a pure chemical
(e.g., “acetone; nitric acid”), or a product
mixture (e.g., “Titan’s Floor Stripper;
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