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Appendix B: Material Safety Data Sheet Template Example


Material Safety Data Sheet
May be used to comply with OSHA's Hazard
Communication Standard, 29 CFR 1910
1200. Standard must be consulted for
specific requirements.
U.S. Department of Labor
Occupational Safety and Health Administration
(Non-Mandatory Form)
Form Approved
OMB No. 1218-0072
Identity (as Used on Label and List) Note: Blank spaces are not permitted. If any item is not applicable or no information is available, the space must be marked to indicate that.
Section I
Manufacturers Name
 
Emergency Telephone Number
 
Address (Number, Street, City, State and ZIP Code)
 
Telephone Number for Information
 

 
Date Prepared
 

 
Signature of Preparer (optional)
 

Section II—Hazardous Ingredients/Identity Information
Hazardous Components (Specific Chemical Identity, Common Name) OSHA PEL ACGIH TLV Other Limits Recommended Percent (optional)
 
 
 
 
 
 
 
 
 
 
 
 
 
Section III—Physical/Chemical Characteristics
Boiling Point
 
 
 
 
 
Specific Gravity
(H20=1)
 
 
 
 
Vapor Pressure
(mm Hg)
 
 
 
 
Melting Point
 
 
 
 
 
Vapor Density
(AIR = 1)
 
 
 
 
Evaporation Rate
(Butyl Acetate = 1)
 
 
 
 
Solubility in Water
 
 
Appearance and Odor
 
 
Section IVFire and Explosion Hazard Data
Flash Point (Method Used)
 
 
Flammable Limits
 
 
LEL
 
  UEL
 
 
Extinguishing Media
 
 
Special Fire Fighting Procedures
 
 

 
 
Unusual Fire and Explosion Hazards
 
 
Extinguishing Media
 
 

 
 
(Reproduce locally)
174 Sept. 1985
OSHA

Source: U.S. Department of Labor, Material Safety Data Sheet, available on the U.S. Chamber of Commerce website.

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