High Hazard

Chemical Permit
Application

PROFESSOR INFORMATION

Principal
Investigator:

Personnel #:

Job Title: Department:

Departmental
Chair:

Date:

Phone Office:
Phone
Emergency:

Permit application type: New Renewal Amendment

DESIGNATE INFORMATION

Designate Name:

Personnel #:

Job Title: Department:

Date:

Phone Office:
Phone
Emergency:

WORK TO BE CONDUCTED

Brief Description:

Chemical Safety Permit Application

Office of Environmental Health and Safety Page 1
Sept. 2013, ver. 1.02
 LOCATIONS WHERE WORK WILL BE CONDUCTED

Please list building and room numbers below:

Please submit your completed application to ehs.office@utoronto.ca

Chemical Safety Permit Application

Office of Environmental Health and Safety Page 2
Sept. 2013, ver. 1.02