42 CFR 85.3-1 - Contents of a request for health hazard evaluation.
Each request for health hazard evaluation shall contain:
(a) The requester's name, address, and telephone number, if any.
(d) Details of the conditions or circumstances which prompted the request.
(e) A statement, if the requester is not the employer, that the requester is:
(1) An authorized representative or an officer of the organization representing the employees for purposes of collective bargaining; or
(2) An employee of the employer and is authorized by two or more employees employed in the same place of employment to represent them for purposes of these Acts (each such authorization shall be in writing and a copy submitted with the request for health hazard evaluation); or
(f) A statement indicating whether or not the name(s) of the requester or those persons who have authorized the requester to represent them may be revealed to the employer by NIOSH.
(g) The following supplementary information if known to the requester:
(2) The trade name, chemical name, and manufacturer of each substance involved;
NIOSH has developed two forms entitled “Request for Health Hazard Evaluation” and “Request for Mining Health Hazard Evaluation” to assist persons in requesting evaluations. The forms are available upon request from the offices listed in § 85.3(a) (1) and (2) or from the Regional Consultant for Occupational Safety and Health in any Regional Office of the Department of Health and Human Services.