Blank (see slide 2 for example & symbols)

Location

Hazards Within:

Primary Contact:

Second Contact:

Building Monitor/Safety:

Department Head:

Fire/Police/Ambulance: 911Envir. Health & Safety (or RSO, if needed): 646-3327

Replace this text with description

of hazards

Replace this text with

hazard symbols

contact name & office phone

contact name & office phone

monitor name & office phone

name & office phone

646-3327 (8-5 m-f ) after hours call 911

Building name & room number

(building name & room number, list subrooms, if any)

Hazards Within:

List hazards such as Flammables, Acids, Bases, General Chemicals, high pressure compressed gases, Biohazards, Radioactive materials, etc

Primary Contact: (name & office phone)

Second Contact: (name & office phone)

Building Monitor/Safety: (name & office phone)

Department Head: (name & office phone)

Fire/Police/Ambulance: 911Envir. Health & Safety (or RSO, if needed): 646-3327