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Hazardous Materials Self Inspection Survey
Section 14i of the Michigan Occupational Safety and Health Act, Act No. 154 of the Public Acts of 1974, as amended, requires that each fire chief prepare and disseminate to each firefighter information on facilities within their jurisdiction that use or produce hazardous chemicals.
The Michigan Fire Prevention Code, Act No. 207, P.A. of 1941, as amended, requires that any firm handling hazardous chemicals provide information to the fire chief upon request. This allows the fire department to gather information on each chemical so that requirements of Act No. 154 can be met.
To assist our department in fulfilling its responsibilities under the Act, we are asking that you complete the form below
HAZARDOUS CHEMICAL DEFINTIONS
Carcinogen – A chemical is considered to be a carcinogen if: 1) It has been evaluated by the International Agency for
Research on Cancer (IARC) and found to be a carcinogen or potential carcinogen; or 2) It is listed as a carcinogen or
potential carcinogen in the Annual Report on Carcinogens published by the National Toxicology Program (NTP) (latest
edition), or 3) It is regulated by OSHA as a carcinogen.
Combustible Liquid – Any liquid having a flashpoint at or above 100 degrees F (37.8 degrees C), but below 300
degrees F (93.3 degrees C), except any mixture having components with flashpoints of 200 degrees F (93.3 degrees C),
or higher, the total volume of which make up 99 percent or more of the volume of the mixture.
Corrosives (liquid and solid) – Any liquid or solid that causes visible destruction or irreversible damage to human skin
tissue. Also, it may be a liquid that has a severe corrosion rate on steel.
Explosives and blasting agent (not including Class C explosives) – “Explosive” means a chemical that causes a
sudden, almost instantaneous release of pressure, gas, and heat when subjected to sudden shock, pressure, or high
temperature. “Blasting Agent” means a material designed for blasting. It must be so insensitive that there is very little
probability of: 1) accidental explosion, or 2) going from burning to detonation
Are there chemicals in your inventory for which OSHA or MIOSHA requires you to maintain Safety Data Sheets (SDS)?
*
Yes
No
*
Indicates required field
Chemical User(chemicals used in activities on site)
*
Chemical Produces (chemicals manufactured at this site, include packaging)
*
Other(If chemicals are stored on site but not used or produced- please specify; ie, service station, retail store, storage facility)
*
Business/Firm Name
*
Address
*
Phone Number
*
Email
*
After Hours Emergency Contact Name
*
Contact Home Phone Number
*
Contact Cell Phone Number
*
Responders Name
*
Date Completed
*
Emergency Contacts Include Private Alarm/Security Companies
Name
*
First
Last
Home/Cell Phone Number
*
Business Phone Number
*
Name
*
First
Last
Home/CellPhone Number
*
Business Phone Number
*
Name
*
First
Last
Home/Cell Number
*
Business Phone Number
*
Respond based on the maximum quantity you would have on-site, including storage at any one time during the year
Check 1 Box for Each Category
Chemical Type/Specified Quantity
Class 1
Explosives & Blasting Agents (Not Including Class C Explosives)/Any Quantity
*
Have at or Above Specified Quantity
Have But Below Specified Quantity
Do Not Have
Storage Location
*
Specified Quantity
*
Class 2
Poison Gas/Any Quantity
*
Have at or Above Specified Quantity
Have But Below Specified Quantity
Do Not Have
Storage Location
*
Specified Quantity
*
Flammable Gas/100 gal. water capacity
*
Have at or Above Specified Quantity
Have But Below Specified Quantity
Do Not Have
Storage Location
*
Specified Quantity
*
Non Flammable Gas/100 gal. water capacity
*
Have at or Above Specified Quantity
Have But Below Specified Quantity
Do Not Have
Storage Location
*
Specified Quantity
*
Class 3
Flammable Liquid/1000 gallons
*
Have at or Above Specified Quantity
Have But Below Specified Quantity
Do Not Have
Storage Location
*
Specified Quantity
*
Combustible Liquid/10,000 gallons
*
Have at or Above Specified Quantity
Have But Below Specified Quantity
Do Not Have
Storage Location
*
Specified Quantity
*
Class 4
Flammable Solid (dangerous when wet)/100 lbs
*
Have at or Above Specified Quantity
Have But Below Specified Quantity
Do Not Have
Storage Location
*
Specified Quantity
*
Flammable Solid/500lbs
*
Have at or Above Specified Quantity
Have But Below Specified Quantity
Do Not Have
Storage Location
*
Specified Quantity
*
Spontaneously Combustible Material/100lbs
*
Have at or Above Specified Quantity
Have But Below Specified Quantity
Do Not Have
Storage Location
*
Specified Quantity
*
Class 5
Oxidizer/500lbs
*
Have at or Above Specified Quantity
Have But Below Specified Quantity
Do Not Have
Storage Location
*
Specified Quantity
*
Organic Peroxide/250lbs
*
Have at or Above Specified Quantity
Have But Below Specified Quantity
Do Not Have
Storage Location
*
Specified Quantity
*
Class 6
Poison/500lbs
*
Have at or Above Specified Quantity
Have But Below Specified Quantity
Do Not Have
Storage Location
*
Specified Quantity
*
Irritating Material: Liquid/1000 gal.
*
Have at or Above Specified Quantity
Have But Below Specified Quantity
Do Not Have
Storage Location
*
Specified Quantity
*
Irritating Material: Solid/500lbs
*
Have at or Above Specified Quantity
Have But Below Specified Quantity
Do Not Have
Storage Location
*
Specified Quantity
*
Class 7
Radioactive Material (Yellow III Label)/Any Quantity
*
Have at or Above Specified Quantity
Have But Below Specified Quantity
Do Not Have
Storage Location
*
Specified Quantity
*
Class 8
Corrosives: Liquid/1000 gal.
*
Have at or Above Specified Quantity
Have But Below Specified Quantity
Do Not Have
Storage Location
*
Specified Quantity
*
Corrosives: Solid/500lbs
*
Have at or Above Specified Quantity
Have But Below Specified Quantity
Do Not Have
Storage Location
*
Specified Quantity
*
No DOT Category
Known Human Carcinogen/Any Category
*
Have at or Above Specified Quantity
Have But Below Specified Quantity
Do Not Have
Storage Location
*
Specified Quantity
*
Additional Information Upload File (8 MB limit)
*
Max file size: 20MB
Submit
Home
Bill Payments
Board Of Trustees
Remote Board Meeting Info
Board Meeting Agendas, Minutes
Board Agendas, Minutes, Video Archived
Budget, Audit, & Schedule of Bills
Past Board Packets
State of the Township Address
Township Calendar
Trustee Calendar
Committees
Committees
Openings
Appointment Guidelines
Conservation Committee
Diversity Committee
Historical Commission
Housing Commission
>
About the Housing Commission
Community Services/Events
Announcements
Rent and Mortgage Assistance
Clinton Twp. TV on YouTube
Clinton Twp. TV Livestream
Community Resources Map
FOIA
Road PASER Study
Trails Map
Clinton River Watershed
Macomb County
Sign up for emergency alerts
State of Michigan
Festival of the Senses
Gratiot Cruise
The Wall That Heals
Departments
Assessing
>
Personal Property
Building
>
Township Ordinances
Clerk & Elections
>
AVlist
Election Results
Passports
Civil Service
>
Commission Agendas & Minutes
Employment
Community Relations & Media Services
>
CTTV on Youtube
Video on Demand
Emergency Management
Fire
>
Fire Stations
SelfInspection
Human Resources
>
Contracts and Agreements
Elected Officials, Appointees
Employee Benefits Portal
Fire & Police Pension
HR Policies
MERS
Retiree Health Care Trust
Township Ethics Portal
Planning & Community Dev.
>
DDA
Economic Development
Planning Commission Agenda & Minutes
Zoning Board of Appeals Agendas & Minutes
Police
Public Services
>
Engineering
Parks
>
Arboretum
Pavilion Rentals
Trash Pickup
Water and Sewer
Recreation
>
Virtual Rec Center
Registration
Partnership Opportunities
Hire Me
Special Events
Senior Center
>
Senior Services
Senior Adventures
Seniors Health and Spa
Seniors Wellness Center
Hidden Treasures Coffee & Gift Shop
Sports & Fitness Schedules
Programs and Acitivities
Smart Transpotation Options
College Scolarship Fund
Supervisor
Treasurer
Public Services
Engineering
Parks
Trash Pickup
Water and Sewer
Recreation
Senior Center
Strategic Vision Plan
Vision Plan/Brand Book