Mining Site Hazardous Material Declaration Form
Mining Site Name
Location
Submitted By
Date
Type(s) of Hazardous Materials Present
Chemical
Explosive
Flammable
Toxic
Corrosive
Other
List of Hazardous Materials
Name of Material
Quantity
Unit
Physical State
Storage Location
kg
l
m³
Other
Solid
Liquid
Gas
kg
l
m³
Other
Solid
Liquid
Gas
kg
l
m³
Other
Solid
Liquid
Gas
Safety Measures and Precautions
Emergency Procedures
Additional Remarks