LifeSafetyWiki · Samektra
Hazard communication work-area checkoff
Hazard Communication and Reading an SDS — employer practical training and certification record
The employee below completed the online portion of hazard communication training on LifeSafetyWiki. Cover Parts 1 and 2 in their work area, then sign Part 3.
Part 1 — Your site (filled in by the employer)
| Hazardous chemicals in this work areaOr the hazard categories they fall into | |
|---|---|
| Where the SDSs are keptBinder location, app or terminal — available every shift | |
| Workplace labeling systemFull GHS labels, a site system, NFPA/HMIS-style labels | |
| Non-routine tasks and unlabeled pipesWhat they are and how hazards are communicated | |
| PPE for these chemicalsFrom SDS Section 8 and the site’s assessment | |
| Emergency proceduresEyewash/shower location, spill kit, who to call |
Part 2 — Hands-on check (by the supervisor or HazCom program coordinator)
| The employee showed they can | OK | Not yet |
|---|---|---|
| Find the SDS for a chemical in the area within a minute1910.1200(g)(8) | ☐ | ☐ |
| Point out first aid (Section 4), spill (6) and PPE (8) on that SDS1910.1200(g)(2) | ☐ | ☐ |
| Read a shipped label and name its six elements1910.1200(f)(1) | ☐ | ☐ |
| Label a secondary container correctly1910.1200(f)(6) | ☐ | ☐ |
| Show the eyewash and spill kit and say when to use them1910.1200(h)(3)(iii) | ☐ | ☐ |
Part 3 — Certification
I certify that the employee named above was trained on the hazardous chemicals in their work area, our labeling system, how to obtain and use Safety Data Sheets, and our protective measures (29 CFR 1910.1200(h)).
HazCom doesn’t prescribe a certification form, but keeping a record of who was trained, when and on what is good practice and helps show compliance. This form does not replace the employer’s own program, and LifeSafetyWiki does not certify competence. Not an OSHA Outreach (10/30-hour) card.