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
    Emergency Contacts Include Private Alarm/Security Companies
    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
    Class 2
    Class 3
    Class 4
    Class 5
    ​Class 6
    Class 7
    Class 8
    No DOT Category
    Max file size: 20MB