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Sample manifest for hazardous chemicals


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Sample manifest for hazardous chemicals


This example is provided to assist the PCBU to develop a manifest that meets the requirements of Schedule 12 of the Work Health and Safety Regulation 2011. The format/layout used here is not mandatory but shows the information to be included. This has been provided in an editable format so the PCBU can choose to adopt it and edit as required. Work through this in conjunction with the guide to Manifest requirements for hazardous chemicals under the Work Health and Safety Act 2011.
The amount of information will depend on the size and complexity of your workplace. The manifest is to be a readily available document presenting the hazardous chemical information clearly and accurately to emergency services for use in an emergency situation.
Update or delete all sections highlighted.

Person Conducting the Business or Undertaking (PCBU)

XYZ Chemicals Company Pty Ltd

Address of premises:

123 Cambridge Street, Eagle Farm, QLD 4009.

Date of preparation:

21 April 2012
Emergency contacts


Name

Position

Telephone

B Wright

Production Supervisor


B/H : 0453 345 378


A/H : 07 3425 6345



A Citizen

Safety Manager


B/H : 0452 454 733


A/H : 07 3029 4563




Hazardous chemicals stored in bulk (add rows as needed)

Storage area

Dangerous Goods




Class

Sub risk/s

PG

Largest quantity

n/a










Nil


Hazardous chemicals stored in tanks (other than IBC’s)

Tank
Id No.


Dangerous goods

Tank

Name

UN No.

Class

Sub risk

PG

Type

Capacity

Diameter

DG T1

Methanol

1230

3

6.1

II

u/g

30 000 L

n/a

DG T2

Abandoned tank

n/a

n/a

n/a

n/a

u/g

30 000 L

n/a

DG T3

LP Gas

1075

2.1

n/a

n/a

a/g

5000 L

n/a

DG T4

Diesel

n/a

Combustible liquid

n/a

n/a

a/g

10 000 L

See note

u/g — underground a/g — aboveground n/a — not applicable
Note: tank diameter required for vertical above ground tanks storing fire risk hazardous chemical (does not apply to combustible liquids).

Package storage areas
The following types of hazardous chemicals must be identified individually:

  1. Class 2.3 -Toxic Gas,

  2. Packing Group I chemicals in any Dangerous Goods Class

  3. Chemicals that are classified as - Goods Too Dangerous to be Transported


Package store 1


Area

Hazardous chemicals

Largest quantity

Name

Class

Sub risk/s

PG

PS1

Chlorine

2.3

5.1 & 8

n/a

70 L


Package store 2

Area

Hazardous chemicals

Largest quantity

Class

Sub risk/s

PG

PS2

6.1

n/a

II

2 500 L

PS2

6.1

n/a

III

12 000 L



Package store 3


Area

Hazardous chemicals

Largest quantity

Name

Class

Sub risk/s

PG

PS3

Carbon disulphide

3

6.1

I

200 L



Area

Hazardous chemicals




Class

Sub Risk/s

PG

Largest quantity

PS3

3

n/a

II

4000 L

PS3

3

n/a

III

8000 L

PS3

Combustible liquid

n/a

n/a

2000 L


Package store 4

Area

Hazardous chemicals

Largest quantity

Class

Sub risk/s

PG

PS4

8

n/a

II

4000 L

PS4

8

n/a

III

8000 L

Manufacturing areas

Area

Hazardous chemicals

Average quantity

Largest quantity

Class

PG

Sub risk/s

MA1

3

II

6.1

2500 L

4000 L

MA2

8

II

n/a

1400 L

2800 L




6.1

III

n/a

600 L

1 200 L




Transit area

Area

Class

PG

Sub risk/s

Largest quantity

n/a










Nil



Note: Any of the above table that are not applicable to your workplace can be deleted from your manifest.

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Note : Please ensure additional information marked with are shown in your site plan.


(i.e. remember to include your map legend for codes used on plan, fire fighting services, main entrance & exits, power isolation points, storm water drains, location of your manifest, who are your neighbours and true north.




Hazardous Industries and Chemicals Branch, May 2016 Page of



PN11453 Workplace Health and Safety Queensland


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