CG-6000-1 PDF Acute Exposure Information Form-2025

1. Click ‘Get Form’ to open the CG-6000-1 PDF Acute Exposure Information Form in our editor.
2. Begin by entering your EMPLID, last name, first name, and middle initial in the designated fields at the top of the form.
3. Fill in the date and time of exposure. This information is crucial for accurate documentation.
4. Specify the name of the chemical you were exposed to, along with its Chemical Abstract Services (CAS) number if known.
5. Indicate the physical form of the chemical (solid, liquid, gas/vapor, aerosol) and select its chemical form (acid, alkali, organic solvent, heavy metals).
6. Detail the modes or routes of exposure and provide an estimate of exposure duration.
7. Describe the incident briefly and list any observed symptoms or associated injuries.
8. Document any personal protective equipment used during exposure and note if further guidance was received from HSWL SC Safety & Environmental Health Officer or ATSDR.
9. Attach any available Material Safety Data Sheet (MSDS) and shipping manifest before submitting your completed form.
10. Finally, ensure that a reviewing authority signature is obtained along with the date for official processing.

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