Published in EC Made Easy, 3rd edition APPLICABLE PROGRAM(S)

Joint Commission Resources, 2020 ☒ AHC ☒ BHC ☒ CAH ☒ HAP

File Name: 05 01 Hazardous Materials Inventory Form ☒ LAB ☒ NCC ☒ OBS ☒ OME

Hazardous Materials Inventory Form Occupational Safety and Health Administration (OSHA) regulations, which the US Environmen
references for chemical inventory requirements, state that a chemical inventory must contain
chemical name, Chemical Abstracts Services (CAS) registry number, common name, synonym
Organization: applicable), and percentage of ingredients in product/mixture (if applicable). The Joint Comm
of hazardous materials and waste; the four-digit Department of Transportation UN identifier
Building: identifier for this hazardous waste if no CAS number is available. If the Safety Data Sheets (SD
Date: information, use of the UN identifier without a CAS number+F148 would be an acceptable ap
Inventory Taker: organization will need additional documentation to cover items not addressed by SDSs. This f
care organizations.

Chemical CAS Common Synonyms Product Mixture Storage Average Hazards PPE

Percentage of Ingredients
Name Number Name Name (if Area Qty.

Staff Training Required

in Product/Mixture
(DOT UN applicable)
Identifier for

(if applicable)
Waste)
 Published in EC Made Easy, 3rd edition APPLICABLE PROGRAM(S)
Joint Commission Resources, 2020 ☒ AHC ☒ BHC ☒ CAH ☒ HAP
File Name: 05 01 Hazardous Materials Inventory Form ☒ LAB ☒ NCC ☒ OBS ☒ OME

© 2020 The Joint Commission. This tool may be adapted for internal use only. Published in The Joint Commission: EC Made Easy, 3rd edition. Oak Brook, IL: Joint Commission Resources, 2020.
 Published in EC Made Easy, 3rd edition APPLICABLE PROGRAM(S)
Joint Commission Resources, 2020 ☒ AHC ☒ BHC ☒ CAH ☒ HAP
File Name: 05 01 Hazardous Materials Inventory Form ☒ LAB ☒ NCC ☒ OBS ☒ OME

US Environmental Protection Agency (EPA)

ry must contain at least the following:
name, synonyms, product/mixture name (if
The Joint Commission requires an inventory
n UN identifier would be an acceptable
Data Sheets (SDSs) provide all the required
acceptable approach. However, the
by SDSs. This form can be used by all health

Unit/Area/Department
Published in EC Made Easy, 3rd edition APPLICABLE PROGRAM(S)
Joint Commission Resources, 2020 ☒ AHC ☒ BHC ☒ CAH ☒ HAP
File Name: 05 01 Hazardous Materials Inventory Form ☒ LAB ☒ NCC ☒ OBS ☒ OME