This form is designed to create a universal register of dangerous goods and hazardous materials. Provide complete and accurate information to ensure safe storage, handling, transport and emergency response.
Register/Document ID
Facility/Site/Operation Name
Physical Location (Address or Coordinates)
Date of Initial Entry
Prepared by (Name & Role)
Reviewed by (Name & Role)
Next Scheduled Review Date
Provide comprehensive identification details for the dangerous good or hazardous material. Use globally recognized classification systems where applicable.
Product/Trade Name
Chemical Name (IUPAC or Common)
CAS Number(s)
UN Number (if applicable)
EC/EINECS/ELINCS/NLP Number(s)
Primary Hazard Classification System Used
UN Model Regulations (Orange Book)
GHS (Globally Harmonized System)
IMDG Code
ICAO TI
ADR
Other:
UN Hazard Class (if applicable)
Class 1 (Explosives)
Class 2 (Gases)
Class 3 (Flammable Liquids)
Class 4.1 (Flammable Solids)
Class 4.2 (Substances Liable to Spontaneous Combustion)
Class 4.3 (Substances which emit Flammable Gases)
Class 5.1 (Oxidizing Substances)
Class 5.2 (Organic Peroxides)
Class 6.1 (Toxic Substances)
Class 6.2 (Infectious Substances)
Class 7 (Radioactive Material)
Class 8 (Corrosive Substances)
Class 9 (Miscellaneous Dangerous Goods)
Not Applicable
GHS Hazard Categories (select all that apply)
Brief Description of Key Hazards
Record the quantities and physical characteristics of the material on site or in transport. Include all relevant units of measurement.
Maximum Quantity Stored/Transported (Value)
Maximum Quantity Unit
kg
tonnes
litres
m³
gallons
pounds
tons
Other:
Average Quantity on Hand (Value)
Physical State at Ambient Temperature
Solid
Liquid
Gas
Plasma
Not Applicable
Form/Packaging Type
Bulk (loose)
Drums
IBC (Intermediate Bulk Container)
Gas Cylinder
Cartridge
Bag
Box
Canister
Other
Are quantities above any regulatory threshold limits?
Detail the conditions under which the material is stored or transported, including segregation requirements and environmental controls.
Storage Location/Zone ID
Storage Method
Indoor Warehouse
Outdoor Yard
Underground Tank
Above-ground Tank
Specialized Cabinet
Refrigerated
Freezer
Controlled Atmosphere
Other:
Storage Temperature (°C)
Storage Pressure (kPa)
Ventilation Type
Natural Ventilation
Mechanical Ventilation
Fume Hood
Local Exhaust Ventilation
Not Applicable
Are incompatible materials segregated?
Safety Measures Present (select all that apply)
Fire Suppression System
Spill Containment
Gas Detection
Temperature Monitoring
Security Access Control
Lightning Protection
Static Electricity Control
None
Is secondary containment provided?
Provide critical information for emergency responders in case of spill, fire, or exposure incidents involving this material.
Emergency Overview (Key Risks & Actions)
Suitable Extinguishing Media
Water Spray
Foam
Carbon Dioxide
Dry Chemical
Sand
Not Applicable
Other:
Unsuitable Extinguishing Media
Water Jet
Foam
Carbon Dioxide
Not Applicable
Other:
Spill Response Actions
First Aid Measures
Is specialized emergency equipment required?
Emergency Contact Number (24-hour)
Specify the minimum PPE and exposure control measures required when handling this material.
Respiratory Protection (select all that apply)
Not Required
Filtering Facepiece (FFP1)
Filtering Facepiece (FFP2)
Filtering Facepiece (FFP3)
Half-mask with A-type filter
Half-mask with B-type filter
Half-mask with E-type filter
Half-mask with K-type filter
Half-mask with P-type filter
Half-mask with multi-type filter
Full face mask with filter
Powered Air-Purifying Respirator (PAPR)
Self-Contained Breathing Apparatus (SCBA)
Air-line Respirator
Other
Eye/Face Protection (select all that apply)
Safety Glasses
Chemical Safety Goggles
Face Shield
Full Face Respirator
Not Required
Hand Protection (select all that apply)
Nitrile Gloves
Neoprene Gloves
PVC Gloves
Butyl Rubber Gloves
Natural Rubber Gloves
Leather Gloves
Heat-resistant Gloves
Not Required
Other:
Body Protection (select all that apply)
Standard Work Clothing
Chemical-resistant Suit
Flame-resistant Clothing
Anti-static Clothing
Encapsulating Suit
Apron
Not Required
Other:
Foot Protection (select all that apply)
Safety Shoes
Chemical-resistant Boots
Conductive/Anti-static Footwear
Not Required
Other:
Occupational Exposure Limit (OEL) - 8-hour TWA (mg/m³)
Occupational Exposure Limit - Short Term (STEL) (mg/m³)
Biological Limit Value (if applicable)
Document the regulatory status and environmental impact of the material under major international frameworks.
Is the material subject to international transport regulations?
Is the material listed in major chemical inventories?
Is the material subject to export/import controls?
Persistence & Degradability
Readily Biodegradable
Inherently Biodegradable
Not Readily Biodegradable
Persistent
Not Applicable
Unknown
Bioaccumulation Potential
Low (BCF < 100)
Moderate (BCF 100-500)
High (BCF 500-5000)
Very High (BCF > 5000)
Not Applicable
Unknown
Aquatic Toxicity Classification (GHS)
Category 1 (Very Toxic)
Category 2 (Toxic)
Category 3 (Harmful)
Category 4 (Long-term Hazard)
Not Hazardous
Not Applicable
Unknown
Does the material deplete the ozone layer?
Is the material a greenhouse gas?
Conduct a comprehensive risk assessment for the dangerous good or hazardous material, considering likelihood and severity of potential incidents.
Risk Assessment Matrix
Very Low | Low | Medium | High | Very High | |
|---|---|---|---|---|---|
Fire/Explosion Risk | |||||
Health Risk (Acute) | |||||
Health Risk (Chronic) | |||||
Environmental Risk | |||||
Reactivity Risk | |||||
Security Risk |
Is a quantitative risk assessment available?
Existing Control Measures (select all that apply)
Substitution with Less Hazardous Material
Process Modification
Engineering Controls
Administrative Controls
PPE
Emergency Response Plan
Training & Competency
Regular Inspections
None
Additional Risk Mitigation Measures
Is the material included in the emergency response plan?
Ensure that all personnel involved in handling, storing or transporting the material are adequately trained and competent.
Is specialized training required for this material?
Training Frequency (months)
Training Provider/Certification Body
Are competency assessments conducted?
Training Records Location/Reference
Provide references to key documents and sources of information for this dangerous good or hazardous material.
Safety Data Sheet (SDS) Reference Number
SDS Date of Issue
SDS Version/Revision
Upload Current SDS
Transport Document Reference
Risk Assessment Document Reference
Additional References/Sources
Last Updated By (Name & Role)
Last Update Date