|| Chemical Usage Assessment Form

Chemical Usage Assessment Form

Chemical Information

What chemical(s) will be in use? Include information regarding whether the chemicals will be used individually, simultaneously, or in a mixture. If chemicals are being used as a mixture, what are the approximate amounts of each chemical? For example, a mixture may contain 20% hexane and 80% octane.
Chemical 1 Chemical 2 Chemical 3
Additional chemicals   Usage Details (mixture, individual, etc.)
 

Estimate how much of the chemical(s) is/are lost to evaporation in units of volume/time. This may be in many forms such as ml/min or L/month.

For example, a 500 ml bottle of toluene is used for two hours per day and is lost over 2 weeks:
2 hours x 60 min/hour x 5 days/week x 2 weeks= 1200 minutes to lose the toluene to evaporation. Divide the 500 ml by 1200 minutes to get .41 ml/min.

Chemical 1 evaporation rate Chemical 2 evaporation rate Chemical 3 evaporation rate
Additional Chemicals evaporation rate(s)

If evaporation rate is unknown, the type of container the chemical(s) is/are normally stored or used in is helpful. Different sizes of beakers or flasks will be common. If flasks and/or beakers are not used, estimate the exposed surface area of the container used. also include the amount of time the container is open or area is exposed during use.

Type(s) of storage containers or surface areas over time
At what temperature is/are the chemical(s) normally used? Is/are the chemical(s) being boiled or heated in any way?
Temperature (designate Fahrenheit or Celsius)
 

Other needs or concerns:
     

Contact Information
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Street Address Address 2  
 
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