Name of person making request:
Name of material:
Where will it be used:
What will it be used for:
How will it be used and under what conditions:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Who will use the material:
Frequency of use:
Proposed storage requirements (qty):
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Replacing existing
material: Yes / No
Material Name: (If yes)
Reason for replacement:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Current Material
Safety Data Sheet available (less than 3 years) and attached: Yes / No
Manufacturers Name:
Suppliers Name:
FORM TO BE RETURNED
TO EHS MANAGER
NB: New Material not to be used until Approval obtained
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