Workbook for Designated Substance Assessments
10
366-BPV-01-IMOT © 2024, Workplace Safety & Prevention Services (WSPS)
1 877 494 WSPS (9777) | 905 614 1400 | WSPS.CA
APPLICATION – WORKSHEET 1: IS THE DESIGNATED SUBSTANCE PRESENT?
1. Do any safety data sheets from your suppliers indicate the presence of the substance?
YES NO
2. If substance is present, indicate the department where it is used, nature of the use (i.e. direct or indirect)
and the quantity purchased per month or year:
Product Name Department
How Used?
Direct/Indirect
Container
Type/Size
Quantity used per
Month/year
CONCLUSIONS
Read statements and check applicable box:
Substance not present anywhere in workplace; regulation does not apply. No Assessment needed.
(Note: Although you do not need to proceed further, you should retain this worksheet on record.)
Date Completed: ____________________________________________
Processes activities have been identified where substance present.
Proceed to worksheet 2.
WSPS.CA
