1. Safety Data Sheet Form_[product name]
Section 1. Product and Company Identification
Commercial Product Name __________
Product Code (Registration Numbers) __________
Relevant identified usesand exposure scenarios (ESs)__________
Supplier
Email
Emergency Phone number, US
Medical Emergency Phone number, US
Chemtrec Emergency Phone number, US
Chemtrec Emergency Phone number, Europe
Section 2. Hazards Identification
Physical Properties__________
Emergency Overview__________
Classification __________
per 67/548/EEC –
Classification Label
1999/45/EC
Label elements__________ per CLP (add authorization number
if applicable)
[Hazard Statements/R-phrases, max 6]
[Precautionary Statements/S-phrases,, max 6]
Potential Health Effects__________
Warning [OSHA Reg]__________
Section 3. Composition/Informationon Ingredients
Substance__________
CAS/EC Reg Num Chemical Name Conc Classification
Mixture__________
Weight
Class
CAS # EC # Index # % or Name Class CLP
EEC
range
Include any impurities, stabilising additives or individual constituent_________
Section 4. First Aid Measures
Inhalation __________
Skin contact__________
Eye contact__________
Ingestion __________
Indication of immediate medical attention and special treatment needed______
Section 5. Firefighting Measures
Suitable extinguishing media __________
Unsuitable extinguishing media __________
Products of Combustion/Special Hazards __________
Issue Date: 2/15/2012
Page 1 of 1
Date of Last Change: 10/24/2009

2. Safety Data Sheet Form_[product name]
Advice for firefighters __________
Section 6. Accidental Release Measures
Personal precautions, protective equipment and emergency procedures _______
Environmental precautions __________
Methods and materials for containment and cleaning up __________
Other information __________
Section 7. Handling and Storage
Precautions for safe handling __________
Conditions for safe storage, including any incompatibilities__________
Measures to prevent emissions __________
See ES if attached
Industry-Specific Guidance as per specific uses__________
Section 8. Exposure Controls/Personal Protection
Control parameters __________
[Describe Control Binding Approach when used to decide on risk management
measures]______
Derived No Effect level (DNELs)for human health hazards__________
Predicted No Effect Concentration (PNECs)for hazards to the environment_____
Engineering and environmental exposure controls __________
Skin, hand and body protection__________
Respiratory protection __________
Eye protection __________
Section 9 Physical and Chemical Properties
Appearance, Physical State __________
Odor, Odor Threshold __________
pH __________
Melting point/freezing point __________
Initial boiling point and range __________
Flash point __________
Evaporation rate __________
Flammability (solid, gas) __________
Vapour pressure (°C) __________
Vapour density __________
Relative density (°C) __________
Water solubility __________
Fat solubility __________
Partition coefficient n-octanol/water __________
Auto-ignition temperature __________
Decomposition temperature (% volatile wt) __________
Viscosity (mm2/s) __________
Explosive properties __________
Oxidising properties __________
Miscibility __________
Conductivity __________
Gas group __________
Safety information on Redox potential __________
Issue Date: 2/15/2012
Page 2 of 2
Date of Last Change: 10/24/2009

3. Safety Data Sheet Form_[product name]
Section 10. Stability and Reactivity
Reactivity __________
Chemical stability(normal) __________
Possibility of hazardous reactions_________
Conditions to avoid(when product becomes chemically unstable/to manage
risks)_______
Incompatible materials__________
Hazardous decomposition products(from storage or handling)__________
Section 11. Toxicological Information
Chronic toxicity(species, method, route of exposure, effective dose, results)______
Acute toxicity(species, method, route of exposure, effective dose, results)_________
Skin Irritation and corrosion __________
Respiratory and/or Skin Sensitisation __________
STOT-single exposure __________
STOT-repeated exposure __________
Aspiration hazard __________
Carcinogenicity, Mutagenicity,
Reproductive Toxicity (CMR) __________
LD50 (Species and Route) __________
Section 12. Ecological Information
Chronic Toxicity(short-term water and other organism)__________
AcuteToxicity(long-term) __________
Biodegradation __________
Chemical degradation __________
Bio-accumulative potential __________
Mobility in soil __________
Results of PBT and vPvB assessment __________
Environmental Fate Exposure__________
Section 13. Disposal Considerations
Waste treatment methods __________
Waste from residues / unused products __________
Section 14. Transport Information
UN number__________
UN proper shipping name__________
Special precautions for users __________
Transport in bulk according to Annex II of MARPOL73/78 and the IBC Code(Product
Name, Ship type, pollution category)____
Issue Date: 2/15/2012
Page 3 of 3
Date of Last Change: 10/24/2009

4. Safety Data Sheet Form_[product name]
Section 15.Regulatory Information
[If a controlled substance exist __________
This product has been classified according to the hazard criteria of the Controlled Products
Regulation (CPR) and the SDS contains all of the information required by the CPR.]
Chemical safety assessment__________
*Safety, health and environmental regulations/legislation specific for the substance
or mixture (EU Info: Classifications, symbols, risk phrases and
hazard/precautionarystatements; same as Section 2)__________
*Restrictions on Use(or limit values for exposure at the place of work)__________
*Product Registration Data (China, Canada, etc)_________________i
Section 16. Other Information
Revision Change Details(based on new revision of this document)__________
NFPA 704 National Fire Protection Association (rating 0-4)__________
Health __________ Fire__________Reactivity__________
Key literature references and sources for data __________
Classification and Procedure (used toderive class for mixture)__________
List of relevant R phrases(hazard statements, safety phrases and/or precautionary
statements)__________ □
Prepared by RA Department, Thermofisher Fremont__________
Acronyms(see the Glossary section of the SDS SOP , document number)
CHEMTREC Chemical Transportation Emergency Center
CLP Classification Labelling Packaging Regulation ; Regulation EC No 1272/2008
IATA International Air Transport Association
Additional information available from__________
The information in this datasheet is to our best knowledge correct and complete,
and is offered in good faith as accurate. It characterizes the product with regard to
the appropriate safety precautions. It does not guarantee properties of the product.
Disclaimer
The information contained in this document applies to this specific material as
supplied. It may not be valid for this material if it is used in combination with any
other material. It is the user responsibility to satisfy oneself as to the suitability
and completeness of this information for his own particular use. This information is
based upon the present state of our knowledge.
[Example] Table format
Hazard Hazard Signal
International
Index # EC # CAS# Class& Statement Word Notes
Chemical ID
Category Code Code
613-169-00-6 9-vinycarbazole 216-055- 1484-13- Muta. 2 H341 GHS08
0 5
*Annex X for ESs (if applicable)
i
* Optional or as applicable.
Issue Date: 2/15/2012
Page 4 of 4
Date of Last Change: 10/24/2009