Title: CHEMICAL APPROVAL REQUEST
Form: S0004
Version: 08/13
CHEMICAL APPROVAL REQUEST
Registration No.
(for site use if applicable
1. SECTION 1 – ORIGINATOR INFORMATION
Callide Power Station
Originator’s Name
Kogan Creek Power Station
Phone Number
Wivenhoe Power Station
Date
Obsolete Chemical (Complete Section 2 and forward to Site Chemical Coordinator / Site Cataloguer)
New Chemical (Complete Section 3 and forward to Site Chemical Coordinator / Site Cataloguer)
Test Chemical (Complete Section 3 and forward to Site Chemical Coordinator / Site Cataloguer)
Change to existing Approved Chemical (Complete Section 3 and forward to Site Chemical Coordinator / Site Cataloguer)
2. SECTION 2 – OBSOLETE CHEMICAL
Material Number
Description
Reason for Deletion
Has the chemical been removed form site / disposed of?
YES
NO
3. SECTION 3 – NEW CHEMICAL / TEST USE
Name of Chemical
Maximum volume to be brought onto site (must state unit of measure)
Full description of task / process / location for which the chemical is to be used
Yes
No
Yes
No
If YES, has the replaced chemical/s been removed or disposed of?
Yes
No
If YES, is the new chemical less hazardous?
Yes
No
Yes
No
Yes
No
Yes
No
Is specific training required in the use, storage, handling or disposal of the chemical?
Yes
No
Is there a waste stream associated with the use of the chemical?
Yes
No
Yes
No
Is this a trial chemical?
If YES, state duration of trial:
Is this chemical replacing an existing chemical/s?
If YES, which chemical/s?:
If NO, why is it being used?:
Will the chemical be used on an ongoing basis?
Where will the chemical be stored (for permanent or trial use)
Has a risk assessment been undertaken to include environmental, health and safety risks?
(Attach risk assessment to this form)
Are there specific environmental, health or safety requirements associated with the purchase, use,
storage, handling or disposal of the chemical? (e.g. – PPE, spill equipment, storage compatibility)
Briefly describe the requirements and how they will be managed:
If YES, how will it be managed?:
Are there costs associated with disposal?
If YES, what is the estimated cost?:
Who are the potential suppliers?:
THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT
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Title:
Form: S0004
Version: 08/13
CHEMICAL APPROVAL REQUEST
Registration No.
(for site use if applicable
4. SECTION 4 – CHANGE TO EXISTING APPROVED CHEMICAL
Increase in maximum volume
Decrease in maximum volume
Storage Location
Other (please specify)
Briefly explain the reason for the change:
5. SECTION 5 – APPROVED TO USE ON SITE
Approved
Position Title:
Not Approved
Site Chemical Coordinator
Name:
Signature:
Date:
6. SECTION 6 – ENTRY OR DELETION CATALOGUE / CHEMALERT
Entry
Position Title:
Deletion
Material No
Site Cataloguer
Name:
Signature:
Position Title:
Date:
Site Chemical Coordinator
Name:
Signature:
Date:
NOTE: MSDS & Risk Assessment must be attached.
Please attach any other information that will assist in the approval process.
The Site Chemical Coordinator must retain a copy of the completed form
THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT
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