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Chemical & Laboratory Safety

"Right to Know"
Chemical Information Request Form


Information requests may be submitted by phone or in writing at any time. This form is provided to assist employees in requesting information concerning the health and safety hazards of toxic substances found in the workplace. Use this form or a copy for your convenience. If you have questions, call Environmental Health and Safety at 254-8300. Send written requests to Environmental Health and Safety, 395 Pine Tree Road, Suite 210, Ithaca, NY, 14850.

Name: Department:
Campus Phone: Campus Address:

List chemicals for which you would like us to send Material Safety Data Sheets. If a trade product, or if the substance is uncommon, please provide manufacturer's name.

ChemicalManufacturer's Name
One chemical is required in #1
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List chemicals for which you would like more detailed information, or list specific questions you have. Include pertinent details such as physical form of substance, amount used, and conditions of use.