OSHE,CSNANO
Chemical Register/2015
Centre for Sustainable Nanomaterials
Ibnu Sina Institute for Scientific and Industrial Research, Universiti Teknologi Malaysia
REGISTER OF CHEMICALS HAZARDOUS TO HEALTH
SECTION A : COMPANY INFORMATION
Name
: C E N T R E
O F
S U S T A I N A B L E
DOSH Registration No. :
N A N O MA T E R I A L S
Address : C E N T R E
O F
S U S T A I N A B L E
N A N O MA T E R I A L S
City
: J O H O R
State
: J O H O R
Telephone No.
Email
: d i
:
B A H R U
U T M
S K U D A I
Postcode : 8 1 3 1 0
2 3
Class of Industry :
9 3 1 0 0
Company Activity (Please enter ( / ) in the appropriate box :
0 7 - 5 5 3 6 0 6 0
r e c t o r @ i b n u s i n a . u t m.
Code of Sector :
m y
Manufacturer
Distributor
Formulator
Importer
End-User
:
:
:
:
OSHE,CSNANO
Chemical Register/2015
Centre for Sustainable Nanomaterials
Ibnu Sina Institute for Scientific and Industrial Research, Universiti Teknologi Malaysia
SECTION B : LIST OF CHEMICALS HAZARDOUS CHEMICAL TO HEALTH
**(Refer to Appendix 1 for providing guide to completer the register)**
Location :
No. of Workers : Male :
No. of Hazardous Chemical :
Process Operation :
Female :
Type of Control Measures
Product Name
Name of
Chemical
Physical Form
of Chemical
No. of Worker
Exposed
Usage Of
Chemical
CAS No.
Engineering
Control
PPE
Type # Quantity##
Comply with
Classification, Labeling
Name of Active and Safety Data Sheet
CLASS 2013
Ingredients
CSDS
(Y/N)
Class
Name, Address of Supplier
and Contact Number (Tel.
No/email)
Label
(Y/N)
SECTION C : NAME OF PERSON WHO PREPARED OF REVIEWED
PREPARED BY :
REVIEWED BY :
Name :
Name :
Title :
Title :
Date :
Date :
(Signature)
(Signature)
OSHE,CSNANO
Chemical Register/2015
Centre for Sustainable Nanomaterials
Ibnu Sina Institute for Scientific and Industrial Research, Universiti Teknologi Malaysia