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CODE OF SECTOR

CODE TYPE OF SECTOR

1 MANUFACTURING
2 MINING AND QUARRYING
3 CONSTRUCTION
4 AGRICULTURE
5 FORESTRY
6 FISHERY
7 LOGGING
8 ELECTRICITY UTILITY
9 GAS UTILITY
10 WATER UTILITY
11 SANITARY UTILITY
12 TRANSPORT
13 STORAGE
14 COMMUNICATION
15 WHOLESALE
16 RETAIL TRADES
17 HOTELS
18 RESTAURANTS
19 FINANCE
20 INSURANCE
21 REAL ESTATE
22 BUSINESS SURVICES
23 PUBLIC SURVICES
24 STATUTORY AUTHORITIES
 APPENDIX 3

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 APPENDIX 4

REGISTER OF CHEMICALS HAZARDOUS TO HEALTH

SECTION A: COMPANY INFORMATION

Name:
DOSH Registration No.:

(Refer to Appendix 4 for Code of Sector and Appendix 5 for Class of

Industry)
Address:

Code of Sector:

City: Postcode: Class of Industry:

State: Company Activity (Please enter (/) in the appropriate box:

Telephone No.: Manufacturer:

Distributor:

e-mail: Formulator:

Importer:

End-User:
 SECTION B: LIST OF CHEMICALS HAZARDOUS CHEMICALS TO HEALTH

Location: No. of Workers:

No. of Hazardous Chemical:
Male:
Process Operation:
Female:

Product Name Name of Type of Usage CAS No. Comply with Classification, Name, Address of Supplier and Contact Number (Tel. No/ e-
Chemical Control Of Chemical # <#="+= mail)
Measures #+
7
& #% $$"+=
"
= $# " +9
# * 2:;;
$
Worker
Exposed

*
Chemical
PPE
Engineering Type # Quantity ## CSDS Class Label
Control (Y/N) (Y/N)

Unleaded Not L 3 PVC P 250 m3/mth 86290-81-5 Gasoline Y Y Y XYZ Malaysia Sdn Bhd, 27 Jln Ipoh, K. Lumpur
Tel. No. 03 – 2907170
Gasoline – applicable Glove 71-43-2 Benzene Y Y Y
Premium grade
SAP 9436 Not L 2 Respirator P 3500 m3/mthyr
1330-20-7 xylene Y Y Y AAA Malaysia Sdn Bhd, Lot 21 Senawang Industrial Estate,
applicable N. Sembilan
Tel. No. 06 - 4056673
SECTION C: NAME OF PERSON WHO PREPARED OR REVIEWED

PREPARED BY: REVIEWED BY:

#! 6 Name:

Title: Title:

Date: Date:
_______________________ _____________________
(Signature) (Signature)
 APPENDIX 5

REGISTER OF CHEMICALS HAZARDOUS TO HEALTH

SECTION A: COMPANY INFORMATION

Name:
DOSH Registration No.:

(Refer to Appendix 4 for Code of Sector and Appendix 5 for Class of

Industry)
Address:
Code of Sector:

Class of Industry:

City: Postcode:

Company Activity (Please enter (/) in the appropriate box:

State:
Manufacturer:

Distributor:
Telephone No.:
Formulator:

e-mail: Importer:

End-User:
 SECTION B: LIST OF CHEMICALS HAZARDOUS CHEMICALS TO HEALTH

Location: No. of Workers:

No. of Hazardous Chemical:
Male:

Process Operation: Female:

Product Name Name of Type of Usage CAS No. Comply with Classification, Name, Address of Supplier and Contact Number (Tel. No/ e-
Chemical Control Of Chemical # # <#="+= mail)
7 Measures ! #+
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EngineeringPPE Type Quantity CSDS Class Label
Control (Y/N) (Y/N)
 SECTION C: NAME OF PERSON WHO PREPARED OR REVIEWED

PREPARED BY: REVIEWED BY:

#! 6 Name:

Title: Title:

Date: Date:
_______________________ _____________________
(Signature) (Signature)
 SECTION B: LIST OF CHEMICALS HAZARDOUS CHEMICALS TO HEALTH

Location: No. of Workers:

No. of Hazardous Chemical:
Male:
Process Operation:
Female:

Product Name Name of Type of Usage CAS No. Comply with Classification, Name, Address of Supplier and Contact Number (Tel. No/ e-
Chemical Control Of Chemical # <#="+= mail)
7 Measures #+
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Control (Y/N) (Y/N)
 SECTION C: NAME OF PERSON WHO PREPARED OR REVIEWED

PREPARED BY: REVIEWED BY:

#! 6 Name:

Title: Title:

Date: Date:
_______________________ _____________________
(Signature) (Signature)