Workplace Hazardous Substance Declaration of Intention Form
Please complete this form to declare your intention to handle, use, or work near hazardous substances in the workplace. All fields are required for safety and compliance purposes.
Full Name
*
First Name
Last Name
Job Title / Role
*
Department or Work Area
*
Work Email Address
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Name of Hazardous Substance
*
Intended Activity (e.g., handling, storage, disposal, working nearby)
*
Location of Intended Activity (building/area/room)
*
Date of Intended Activity
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Declaration
Should be Empty: