Health & Safety Division

Online Hazardous Substance Survey Form (HSSF)

Overview - Electronic Form:

The Health & Safety Division's Online Hazardous Substance Survey Form (HSSF) enables public sector employers to complete the annual survey and meet Pennsylvania’s reporting requirements as defined under Act 1984-159. The Online HSSF allows you to report information about the hazardous substances, special hazardous substances and environmental hazards that are present at your workplace and are regulated by the state Worker and Community Right to Know Act.
 
The Online HSSF also provides you with access to the PA Hazardous Substance List. This list includes 2,333 substances that have been identified by the department to pose health hazards and/or safety concerns. Of these 2,333 substances, 188 do not have an assigned Chemical Abstract Service (CAS) number. For Online HSSF reporting purposes, these 188 substances have been assigned a unique PA number (PA001-00-0 through PA188-00-0). The PA numbers are only listed on the Online HSSF version of the Chemical Abstract List to cross reference a chemical name from a Material Safety Data Sheet (MSDS)/Safety Data Sheet (SDS) with a chemical name on PA’s list of regulated substances, if no CAS number is available. The PA numbers will not be found on the MSDS/SDS but should be entered on the online survey form if any of these substances are in your workplace.
 

Manual Form:

Click on the following link to complete the HSSF manually: LIBC-261
 
For more information on the completion of either version of the form, 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
RA-LI-BWC-SAFETY@pa.gov
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