Chemical Survey

Chemical Survey
2024 Chemical Survey Instructions

Indicate whether your site uses or produces any of the chemical types listed. Check all the categories that apply when a chemical has more than one characteristic: e.g., both a Class 3 flammable and a Class 6 poison. Each chemical group listed in this survey includes a specified quantity. Indicate the quantity category for each chemical group on your site. To complete this survey, you may need to reference Material Safety Data Sheets and other reporting forms.

Complete each line. Do not leave blanks. If you do not use a chemical group listed, choose "DO NOT HAVE" in the drop down list.

When substantial changes occur in the quantity or type of chemical use, manufacture or related storage, a revised survey must be submitted to the fire department.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Name
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Chemical User (chemicals used in the activities on site)Chemical Producer (chemicals manufactured at this site, including packaging)Other (e.g., chemicals are stored on site but not used or produced such as a service station, retail store, storage facility, etc.)
Class 1
Explosive & Blasting Agents (Not including Class C Explosives) - Any Quantity
Class 2
Poison Gas - Any Quantity
Flammable Gas - 100 gal. water capacity
Non-flammable Gas - 100 gal. water capacity
Class 3
Flammable Liquid - 1,000 gal.
Combustible Liquid - 10,000 gal.
Class 4
Flammable Solid (Dangerous when wet) - 100 lbs.
Flammable Solid - 500 lbs.
Spontaneously Combustible Material - 100 lbs.
Class 5
Oxidizer - 500 lbs.
Organic Peroxide - 250 lbs.
Class 6
Poison - 500 lbs.
Irritating Material: Liquid - 1,000 gal.
Irritating Material: Solid - 500 lbs.
Class 7
Radioactive Material (Yellow III Label) - Any Quantity
Class 8
Corrosives: Liquid - 1,000 gal.
Corrosives: Solid - 500 lbs.
No DOT Category
Known Human Carcinogen - Any Quantity
Should be Empty:

Chemical Survey

Class 1

Class 2

Class 3

Class 4

Class 5

Class 6

Class 7

Class 8

No DOT Category