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: 




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:  



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.