Safety Data Sheet Sample Form
24-hour emergency- (INFOTRAC #1-800-535-5053) Submit Copy to the Office of Safety (STOP 9031, 701-777-3341)
Section 1.IDENTIFICATION
Product Name: _________________________________________________________________________________
Product Use: ____________________________________________________________________________________
Synonyms: _____________________________________________________________________________________
Other Designations: ______________________________________________________________________________
______________________________________________________________________________________________
Section 2.HAZARD(S) IDENTIFICATION
Ratings:
Health____ Flammability___ Reactivity___ Primary Route of Exposure: _____Skin ___ Inhalation ___Eye
Health Effect Information:
Eye Contact:__________________ Skin Contact:_________________ Inhalation:______________________________
Ingestion:_____________________ Medical Conditions Aggravated by Exposure: _____________________________
Section 3.COMPOSITION INFORMATION ON INGREDIENTS
This product is hazardous according OSHA 29 CFR 1910.1200.Hazards:
____Flammable/Combustible ____Acute Toxin ___Chronic Toxin ___Carcinogen
Pressure_____ Reactive_____ Exposure Limits___________ Target Organ(s)_________________________
Other__________________________________________
Section 4. FIRST AID MEASURES
Eye Contact: ____________________________________ Skin Contact:_____________________________________
Inhalation: ______________________________________ Ingestion:._______________________________________
Notes to Physician:_______________________________________________________________________________
Section 5. FIRE-FIGHTING MEASURES
Flammable Properties:_____________________________________________________________________________
Flash Point: _____ Test Method: __________________________________________
Flame extension: ____Test Method: __________________________________________
Flammable Limits in Air: Upper Percent:_____ Lower Percent:_____
Autoignition Temperature :_____Test Method: __________________________________
NFPA Classification: (see NFPA 704 marking system):__________________________________________________
Extinguishing Media: ____________________________________________________________________________
Fire Fighting Measures:
Special Fire Fighting Procedures and Equipment: __________________________
Unusual Fire and Explosion Conditions: _________________________________
Hazardous Combustion By-Products: ___________________________________
Section 6. ACCIDENTAL RELEASE MEASURES
Personnel Safeguards: ____________________ Regulatory Notifications: ____________________________________
Containment and Clean up: _________________________________________________________________________
_______________________________________________________________________________________________
Section 7. HANDLING AND STORAGE
Handling: _____________________________Storage: ____________________________
Empty Container Warnings:
Drums: ___________________________________________________________
Plastic: ___________________________________________________________
Section 8. EXPOSURE CONTROLS / PERSONAL PROTECTION
Exposure Limits and Guidelines:
Component CAS No. Exposure Limit
Personal Protective Equipment:
Eye/Face Protection: ______________________________ Skin Protection:__________________________
Respiratory Protection:____________________________ Personal Hygiene: _________________________
Engineering Controls / Work Practices
Ventilation: _____________________________________________________________________________
Other: __________________________________________________________________________________
Section 9.PHYSICAL AND CHEMICAL PROPERTIES
Appearance: Vapor Pressure:
Odor:
Physical state: Vapor Density (air=1):
pH: Percent Volatile by Volume:
DOT Corrosivity: Volatile Organic Content:
Boiling Point: Molecular Weight:
Melting Point: Average Carbon Number:
Specific Gravity: Viscosity @ 100 F:
Pour Point: Viscosity @ 40 C:
Solubility in Water:
Octanol / Water Coefficient: Log Kow =
Section 10. STABILITY AND REACTIVITY
Chemical Stability: ___________________________Conditions to Avoid: __________________________________
Incompatible Materials to Avoid: ____________________________________________________________________
Section 11. TOXICOLOGICAL INFORMATION
Primary Eye Irritation: _________________________ Primary Skin Irritation: _______________________________
Acute Dermal Toxicity: ________________________ Subacute Dermal Toxicity:_____________________________
Dermal Sensitization: __________________________ Inhalation Toxicity: __________________________________
Inhalation Sensitization: _______________________ Oral Toxicity:________________________________________
Mutagenicity: _______________________________ Carcinogenicity: _____________________________________
Reproductive Toxicity: ________________________ Teratogenicity: _______________________________________
Immunotoxicity: _____________________________ Neurotoxicity: ________________________________________
Other: ________________________________ or _____No other toxicological information available
Section 12. ECOLOGICAL INFORMATION
Aquatic Toxicity: ____________________________ Terrestrial Toxicity: ____________________________________
Chemical Fate and Transport: ________________ or _____No other ecological information available.
Section 13. DISPOSAL CONSIDERATIONS
Regulatory Information: ______________________ Waste Disposal Methods: ________________________________
Section 14. TRANSPORTATION INFORMATION
U.S. Department of Transportation (DOT):_____________________________________________________________
Highway / Rail (Bulk): _____________________________________________________________________________
Highway / Rail (Non-Bulk): ________________________________________________________________________
The DOT description is provided to assist in the proper shipping classification of this product and may not be suitable for all
shipping descriptions.
International Information:
Vessel: ____IMDG Regulated: ____IMDG Not Regulated:
Air:____ICAO Regulated: ____ICAO Not Regulated:
Other information:_______________________________ or ______No other information available.
Section 15. REGULATORY INFORMATION
Regulatory Lists
U.S. TSCA Inventory: All components of this material are on the US TSCA Inventory.
Sara Section 313: This product contains the following Sara, Title III, Section 313 Chemicals:
Chemical CAS Number Percent in Product
IARC Group 3:
Regulatory Lists Searched:________________________ Health & Safety: ___________________________________
Environmental:_________________________________ International:_______________________________________
State: _________________________________________ National Inventories: ________________________________
SARA 311 / 312 Categories
Acute:_____ Chronic:_____ Fire:_____ Pressure:_____ Reactive:____ Not Regulated:_____
Canadian WHMIS Classification: Class:____ Division:_____
European Union Classification : Hazard Symbol: _____ Risk Phrases: _____Safety Phrases: _____
Other Regulations: ______________________________ or ____No other information available.
Section 16. OTHER INFORMATION
Health and Environmental Label Language: _________________________SDS Last Revision:_____________________
Prepared By: __________________________________________________________ Date:_________________
