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Hazardous Material Declaration - Health & Safety Assessment Report

Hazardous Material Declaration - Health & Safety Assessment Report 2025

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The document is a Hazardous Material Declaration and Health & Safety Assessment Report from Conax Technologies, aimed at ensuring the safety of personnel and compliance with OSHA standards. It requires customers to disclose any hazardous materials that may have been in contact with equipment being returned, along with decontamination details if applicable. The form must be completed to mitigate health risks associated with potentially contaminated equipment.

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Click ‘Get Form’ to open the Hazardous Material Declaration - Health & Safety Assessment Report in the editor.
Begin by filling out the 'To Be Filled Out By Conax Technologies' section, including your Company Name and Date.
Next, provide the Conax Contact information, including the Conax Email.
In the 'To Be Filled Out By Customer' section, enter the RMA# assigned by Conax after approval.
Fill in your Contact Name and Email or Phone # for further communication.
Proceed to Section 1 and indicate whether the product was exposed to any hazardous materials. Choose accordingly and follow prompts to continue.
If applicable, complete Section 2 regarding decontamination status and proceed to Sections 3 and 4 as needed, detailing hazardous materials and decontamination processes.
Finally, ensure you sign and date the document at the bottom before submitting it back to Conax.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (60 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a hazardous material report?

A Hazmat (Hazardous Materials) Report provides information about the transportation of hazardous materials. It includes details such as the type and quantity of the hazardous materials, the transportation route, and the responsible partys contact information.

What is a hazmat assessment?

A Hazardous Materials Assessment (HazMat Assessment) is a comprehensive evaluation of a building to identify materials that may pose health and environmental risks.

What are the five general safety rules for hazardous materials?

This information is provided through material safety data sheets (MSDSs), labels, and employee training. In order for MSDSs, labels, and training to be effective, the hazard information they convey must be complete and accurate.