APPENDIX E

Hazard Communication Contractor/Working Visitor Form

______________________________________________

(UND Department Name)

________________________

(Contractor/Working Visitor)

It is UND policy that facilities using hazardous materials inform contractors and working visitors of the chemical and physical hazards presented in the areas where contractors/working visitors may be working. The following is a guide that may be used to transfer this information.

Brief Description of the Work to be Performed: _____________________________________________________

Potential Hazards (Physical and Health) in the Work Area: ___________________________________________

Material Safety Data Sheet (MSDS) Locations (both UND and Contractor/Working Visitor): ________________

MSDSs Supplied by UND (not required unless requested): ____________________________________________

MSDSs Supplied by Contractor (not required unless requested): _______________________________________


Recommended Personal Protective Equipment:

Hard Hat

Gloves

Safety Glasses

Boots

Chemical Splash Goggles

Coveralls

Apron

Slicker Suit

Respiratory Protection: ____________________________________________

Other: ____________________________________________

 

UND Signature ________________________

Contractor/Working Visitor Signature ________________________