Chemical Use Disclosure & Substitution Form
1. General Information
Project Name
Location
Submitted By
Date
2. Chemical/Product Information
Chemical/Product Name
Manufacturer
Purpose/Use
Quantity Used
Unit
3. Hazard Identification
Known Hazards (health, environmental, etc.)
4. Substitution & Alternatives
Was a safer alternative investigated?
Yes
No
If yes, describe potential alternatives considered and why they were/weren’t selected:
5. Additional Notes / Comments