Intention to Ship Hazardous Materials

Complete and submit this form to EHS if you intend to ship material that may be
classified as hazardous material. EHS will determine if the shipment is regulated and, if
so, will properly prepare your material for shipment.

Today’s date
Your name



Description of material (commercial product name, chemical name, etc.):

Known hazards:

Physical state (liquid, solid, gas):

Quantity (mass and/or volume):

Special requirements (dry ice, overnight, specific carrier, etc.):

Preferred shipping method (FedEx, UPS, DHL, etc.):

Do you plan to transport in School vehicle, in personal vehicle, carry on plane, etc.?

Destination (complete address, no PO boxes allowed, provide destination telephone

Provide CSM account number for the shipping charges ___________________

- or if freight will be paid by recipient, provide means of payment (e.g. the
recipient’s FedEx or UPS account number)