Month & Date: ________________________

1. Name of Section
2. Declared by & Tel No:
Mechanical/Equipment /
Instrument Scrap
Electrical/Electronic
Scrap
3. Nature of Waste Chemicals/Hazardous
Materials
Furniture
Papers / Stationary
Other (Describe)
4. * Type of Waste Solid / Liquid
Waste Characterization / Category Physical & Chemical
5. ** (Short Description) Characteristics &
hazardous Nature
6. Waste Quantity Kgs / M3 / Nos.
7. Type of Packing Disposal
8. Source of Generated Waste
9. Present Location of Waste
10. Storage Method (as per MSDS)
11. Handling Methods (as per MSDS)
12. Disposal methods (as per MSDS)
Note: Cope of MSDS to be attached for the waste (where applicable)
Remarks (if any):
Sign: Sign :
Name: Name:
Section: Division:
Note:
* Must indicate description of waste type (plastic, metal, oil, waste chemical, wastewater, etc.)
** Must indicate hazardous, non-hazardous, toxic, corrosive, reactive flammable, etc.

MANAGEMENT PROCEDURE MANUAL Waste Declaration Form

Document No: KU – FD – EHS – FOR – 70 Issue no: 02 Issue Date: 07.06.2018 Page: 1 of 1
Copies of this document available in KU EHS Intranet are only the latest, valid and controlled documents. All other copies are uncontrolled and valid only on the date printed. Last printed: 19/6/2018 4:44:00 PM