New Material Request Form
To be completed by WCAM Staff
Rec’d by WCAM:Routed to Chemical approval Committee:
Material Approved or disallowed:
Decision communicated to petitioner:
SDS in WCAM Binder:
To be Completed by Petitioner
All Information Boxes must be filled in for this form to be complete and reviewed
Who are you?
Your Name:Email Address:
Your Professor’s Name:
Email Address:
What is it that you want to bring into WCAM
Note, You must attach a copy of the current GHS SDS for this material.
· The request will not be considered until it is received.
Name of the new material:Is this a solid or a liquid (note, generally powders are not permitted):
Composition of the material (i.e. 30% DI water and 70% isopropanol):
Amount of the material that will be present in WCAM:
Is this material/ chemical pre-mixed, if not include what other chemicals you will mix it with.
Please mark the correct SDS Pictogram for your material by placing an X in the box to the right of the Pictogram(s) that apply.
Toxic?
If Yes, What is the OSHA Permissible Exposure Limit (PEL)
This must be followed by TWA or CL to indicate if it is the Time Weighted Average or Ceiling Limit
What is the ACGIH TLV (Threshold Limit Value)
Personal Protective Equipment Needed (what will you wear when you use this material):
Where will you use this new Material
In what system will you use this new material or chemical:Where will you store this new material or chemical:
What other systems will your substrate be processed in after you have used the new material on the substrate:
Disposal
How will you dispose of this when you are using it?How will you dispose of any remaining material when you no longer need it?
Reason for this Request
Explain what you need to do and any relevant information that you have. This is your opportunity to make your case for using this material.
Explain what you need to do and any relevant information that you have. This is your opportunity to make your case for using this material.NewMaterialRequestForm-01.doc Page 3 of 3