L&I LOGO LANDI
HAZARDOUS SUBSTANCE SURVEY FORM
User's Guide
The Pennsylvania Worker and Community Right to Know Act (Act 159 of 1984) requires public sector employers in the commonwealth to report information about the hazardous chemicals used, produced or stored at their work sites. The law also provides for information about hazardous chemicals to be communicated to Pennsylvania’s workers and citizens.
The Pennsylvania Department of Labor & Industry has developed the Online Hazardous Substance Survey Form (HSSF) to assist you in reporting information about the hazardous chemicals present at your facility that are regulated by the state Worker and Community Right to Know Act. Within this program, you will find a copy of the Department of Labor & Industry’s Hazardous Substance List (amended August 1989). This list includes 2,335 substances that have been identified by the department to pose health hazards and/or safety concerns to workers and citizens or that have the potential to be hazardous when released into the environment. Chemicals that have been defined by the department as “special hazardous substances” and “environmental hazards” are identified on the list by “S” and “E”, respectively.
The following Online Hazardous Survey Form program is being provided to allow employers to save and edit this survey electronically. The completed Hazardous Substance Survey Form (HSSF) must be posted in the workplace. It is not necessary to send a copy of the completed HSSF to the Department of Labor & Industry, unless you are sent a written request specifically asking for a copy of the form. If you have any questions about this material or need additional information, please contact
Bureau of Workers’ Compensation
Health & Safety Division
1171 S. Cameron Street, Room 324
Harrisburg, PA 17104

Phone: 717-772-1635
Fax: 717-783-6365
Email: RA-LI-BWC-SAFETY@pa.gov