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Appendix B: Material Safety Data Sheet Template Example

Material Safety Data Sheet
May be used to comply with OSHA's Hazard
Communication Standard, 29 CFR 1910
1200. Standard must be consulted for
specific requirements.
U.S. Department of Labor
Occupational Safety and Health Administration
(Non-Mandatory Form)
Form Approved
OMB No. 1218-0072
Identity (as Used on Label and List) Note: Blank spaces are not permitted. If any item is not applicable or no information is available, the space must be marked to indicate that.
Section I
Manufacturers Name
Emergency Telephone Number
Address (Number, Street, City, State and ZIP Code)
Telephone Number for Information

Date Prepared

Signature of Preparer (optional)

Section II—Hazardous Ingredients/Identity Information
Hazardous Components (Specific Chemical Identity, Common Name) OSHA PEL ACGIH TLV Other Limits Recommended Percent (optional)
Section III—Physical/Chemical Characteristics
Boiling Point
Specific Gravity
Vapor Pressure
(mm Hg)
Melting Point
Vapor Density
(AIR = 1)
Evaporation Rate
(Butyl Acetate = 1)
Solubility in Water
Appearance and Odor
Section IVFire and Explosion Hazard Data
Flash Point (Method Used)
Flammable Limits
Extinguishing Media
Special Fire Fighting Procedures

Unusual Fire and Explosion Hazards
Extinguishing Media

(Reproduce locally)
174 Sept. 1985

Source: U.S. Department of Labor, Material Safety Data Sheet, available on the U.S. Chamber of Commerce website.

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