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
Storage area	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
Tank Id No.	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:

Class 2.3 -Toxic Gas,
Packing Group I chemicals in any Dangerous Goods Class
Chemicals that are classified as - Goods Too Dangerous to be Transported

Package store 1

Area	Hazardous chemicals				Largest quantity
Area	Name	Class	Sub risk/s	PG	Largest quantity
PS1	Chlorine	2.3	5.1 & 8	n/a	70 L

Package store 2

Area	Hazardous chemicals			Largest quantity
Area	Class	Sub risk/s	PG	Largest quantity
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
Area	Name	Class	Sub risk/s	PG	Largest quantity
PS3	Carbon disulphide	3	6.1	I	200 L

Area	Hazardous chemicals
Area	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
Area	Class	Sub risk/s	PG	Largest quantity
PS4	8	n/a	II	4000 L
PS4	8	n/a	III	8000 L

Manufacturing areas

Area	Hazardous chemicals			Average quantity	Largest quantity
Area	Class	PG	Sub risk/s	Average quantity	Largest quantity
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