Chemical request form

---
title: Chemical request form
description: Field and description for a chemical request form. The chemical request form is used by an employee to request for an existing or a new chemical.
locale: en-US
canonical_url: https://www.servicenow.com/docs/r/employee-service-management/health-and-safety/hs-chemical-request-form.html
release: brazil
product: Health and Safety
classification: health-and-safety
topic_type: reference
last_updated: "2026-09-10"
reading_time_minutes: 1
breadcrumb: [Reference, Health and Safety Environmental Management, Health and Safety, Employee Service Management]
---

# Chemical request form

Field and description for a chemical request form. The chemical request form is used by an employee to request for an existing or a new chemical.

<table id="table_zlw_tjl_lhc"><thead><tr><th>

Field

</th><th>

Description

</th></tr></thead><tbody><tr><td>

Select Chemicals

</td><td>

Lists the names of existing chemicals

</td></tr><tr><td>

New Chemical check box

</td><td>

Option to request a chemical that is not in the existing list

</td></tr><tr><td>

New Chemical

</td><td>

Name of the chemical that is not in the existing list

**Note:** This field appears when New chemical check box is selected

</td></tr><tr><td>

Upload

</td><td>

Button to upload a Safety Data Sheet \(SDS\), if available

</td></tr><tr><td>

Approvals due

</td><td>

Date on which approval is needed

</td></tr><tr><td>

Location

</td><td>

Name of the location the chemical will be used in

</td></tr><tr><td>

Cost Center

</td><td>

Department in your organization that pays for the chemical request

</td></tr><tr><td colspan="2">

Usage Details

</td></tr><tr><td>

Describe how the chemical will be used

</td><td>

Description on the use of the chemical

</td></tr><tr><td>

Purpose

</td><td>

Options to select the purpose of the chemical request

</td></tr><tr><td>

Container Type

</td><td>

Type of container holding the chemical

</td></tr><tr><td>

Frequency of Use

</td><td>

Determines how often a chemical will be used.

</td></tr><tr><td>

General period of use

</td><td>

Period when the chemical will be in use

</td></tr><tr><td>

Start date of use

</td><td>

Specific start date for the use of chemical

</td></tr><tr><td>

End date of use

</td><td>

Specific end date for the use of chemical

</td></tr><tr><td colspan="2">

Volume details

</td></tr><tr><td>

Physical state

</td><td>

Physical state of the chemical For example, If the chemical is Gasoline, the physical state is Liquid.

</td></tr><tr><td>

Overall Expected consumption

</td><td>

Value and unit of chemical consumption

</td></tr><tr><td>

Overall Quantity

</td><td>

Total quantity required by the organization

</td></tr><tr><td>

Quantity unit of measure

</td><td>

Unit of measure for the quantity

</td></tr><tr><td colspan="2">

Additional Details

</td></tr><tr><td>

Risk assessment

</td><td>

Option to associate a risk assessment

 Use the \(\[Omitted image "circle-info-outline-24.svg"\] Alt text: info icon\) icon to preview the risk assessment record

</td></tr><tr><td>

JSA

</td><td>

Option to associate a job safety analysis \(JSA\)

 Use the \(\[Omitted image "circle-info-outline-24.svg"\] Alt text: info icon\) icon to preview the JSA record

</td></tr><tr><td>

Additional information

</td><td>

Description of additional information relevant to the chemical request

</td></tr><tr><td>

Attachment

</td><td>

Any additional documents to be attached for the chemical request.

</td></tr></tbody>
</table>**Parent Topic:**[Health and Safety Environmental Management reference](https://raw.githubusercontent.com/ServiceNow/ServiceNowDocs/brazil/markdown/employee-service-management/health-and-safety/hs-reference-environmental-management.md)