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Chemical Survey


  1. 1. General Information
  2. 2. Emergency Contacts
  3. 3. Chemical Information
  • General Information

    1. Items to Note
      Information: Completion of the Chemical Survey is requested to determine the quantity of specific chemical groups used, produced or stored in facilities within the jurisdiction of the Portage Department of Public Safety. The Michigan Occupational Safety and Health Administration (MIOSHA), P.A. 154 of 1974, as amended, and the Fire Prevention Code, PA 207 of 1941, as amended, require that any firm handling hazardous chemicals provide information to the Fire Chief upon request.

      Instructions: Indicate below whether the firm is a user, producer or storer of any of the chemical types listed. Select 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 the Chemical Survey includes a specific quantity. Select the appropriate quantity category for each chemical group on site. Note: Each line of the Chemical Survey must be completed. Do not leave blanks. If a chemical group listed is not used, produced or stored, select "Do Not Have." Reference to Material Safety Data Sheets, SARA Title III reporting forms and/or the Hazardous Chemical Definitions may be required to complete the Chemical Survey.

      When substantial changes occur n the quantity or type of chemical use, manufacture or related storage, a revised survey must be submitted to the Fire Chief. In addition, a revised survey will be requested periodically as the Fire Chief determines necessary, but at a minimum, once every five years.

      If the information provided in the Chemical Survey indicates that the firm is a user, producer or storer of hazardous chemicals and the chemicals on site meet or exceed the specified quantities, the Portage Department of Public Safety - Fire Division will request further information. this may include a request for Material Safety Data Sheets, chemical lists maintained under the Employee Right to Know provisions of MIOSHA and other information.
    2. This firm is a...
      Select all that apply.