Appendix B

Department or Site Specific Information

To make the Hazard Communication (HAZCOM) Plan site specific, the responsible party for the building/section or department completes this section.

Date:___________ Department:____________________________________ 

Section/Building:_____________________ Area/Room Number:___________

Revision Date(s______ ___________ ___________ ___________ ___________

Responsible Party:__________________________________________________

Location of Material Safety Data Sheets:_______________________________

Location of Training Records:________________________________________

MSDS and chemical inventories are considered records of potential exposure.  At least one 

(1) of these records must be maintained for 30 years following the last use.

Check the one (1) maintained:___________ MSDS___________ Chemical Inventory

Location of past records:  

Emergency Procedures (describe)________________________________________

 ____________________________________________________________________

_____________________________________________________________________

Location of Health Care provider:_________________________________________

Location of Eye Wash:___________________________________________________

Location of Emergency Shower:___________________________________________

Gary Lee
Director of Environmental Health
4601 College Blvd.
Farmington, NM  87401
(505) 566-3063 or (505) 566-3190