Download Form for assessing an ingredient

The Swedish Society for Nature Conservation | Good Environmental Choice (Bra Miljöval)
Form for assessing an
ingredient
An ingredient may consist of one or several
chemical substances. This form is to be used for all
types of ingredients except fragrances.
A
INFORMATION ABOUT MANUFACTURER AND SUPPLIER
A1 Manufacturer
Version: 2006:3
Name of company
Corporate ID number
Address
Postcode
City
Telephone (switch board)
Fax
Website
Country
Person to contact
Name
Position
E-mail
Telephone
A2 Supplier (if other than manufacturer)
Name of company
Corporate ID number
Address
Postcode
City
Telephone (switch board)
Fax
Website
Country
Person to contact
Name
Position
E-mail
Telephone
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Form for assessing an ingredient
B
INFORMATION ABOUT THE INGREDIENT
B1 Trade name
B2 Prohibited substances
The ingridient does not contain:
£ Cadmium compounds
£ Lead compounds
£ Mercury compounds
£ Organic halogen compounds
£ Chromium compounds
£ Phthalates
£ Phosphorous compounds
£ Endocrine disrupting chemicals listed in Appendix 1: Endocrine disrupting chemicals
B3 Safety data sheets
A safety data sheet must be submitted to the Swedish Society for Nature Conservation for the ingredient
(see REACH regulations for structure)
£ Safety data sheet sent to e-mail [email protected]
£ Safety data sheet sent by post
C INFORMATION ABOUT CHEMICAL SUBSTANCES
All chemical substances included in the ingredient must be reported in accordance with points C1–C11 below.
Copy the points in section C if the ingredient consists of several chemical substances.
The Swedish Society for Nature Conservation considers all chemical substances that occur in contents over
0.01% as part of the ingredient, regardless of whether or not the chemical substance was added intentionally.
If the chemical substance is a surfactant, complexing agent, solvent or preservative, complete test reports must
be submitted regarding degradability, bioaccumulability and ecotoxicology.
Sections C1, C2 and C11 are to be filled in for all types of substances. The remaining sections are to be filled in for the type of substance/substances stated in the headings.
If a hazard statement covers more than one category, e.g. H300 which covers both acute toxicity category 1
and category 2, and the criteria does not explicitly states otherwise, all categories are included. For certain hazard
statements there exist subvariants, stating the specific effect and/or route of exposure, if those are known. One
example is ”H360Df, May damage the unborn child. Suspected of damaging the unborn child.” Another example is ”H350i, May cause cancer by inhalation”. Note that if a hazard statement is prohibited, the prohibition includes also all subvariants.
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Form for assessing an ingredient
C1 Chemical substance
Name
CAS-number
Included in trade name
C2 Classification of health risk
The chemical substance or its breakdown products are not classified with the hazard statements :
£ H350, May cause cancer
£ H351, Suspected of causing cancer
£ H340, May cause genetic defects
£ H341, Suspected of causing genetic defects
£ H360, May damage fertility or the unborn child
£ H361, Suspected of damaging fertility or the unborn child
£ H362, May cause harm to breast-fed children
C3 Classification of health risks associated with surfactants, complexing agents, solvents,
preservatives, thickening agents and dissolving agents, bleaching agents, acids and
other additives
The chemical substance or its breakdown products are not classified with the hazard statements :
£ H372, Causes damage to organs through prolonged or repeated exposure
£ H373, May cause damage to organs through prolonged or repeated exposure
£ H317, May cause an allergic skin reaction
£ H334, May cause allergy or asthma symptoms or breathing difficulties if inhaled
£ H300, Fatal if swallowed
£ H310, Fatal in contact with skin
£ H330, Fatal if inhaled
£ H301, Toxic if swallowed
£ H311, Toxic in contact with skin
£ H331, Toxic if inhaled
£ H370, Causes damage to organs
C4 Biological substances
The biological substance is not classified as:
£ H317, May cause an allergic skin reaction. Neither is it listed in Annex III (with reference number 67-92) to the cosmetics regulation (EC) No 1223/2009.
£ H372, Causes damage to organs through prolonged or repeated exposure
£ H373, May cause damage to organs through prolonged or repeated exposure
£ H317, May cause an allergic skin reaction
£ H334, May cause allergy or asthma symptoms or breathing difficulties if inhaled
The extraction agents used must be supplied in a list appended to the application. The list must contain all
extraction agents and their CAS-numbers.
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Form for assessing an ingredient
C5 Aerobic degradability
Aerobic degradability must be reported for organic chemical substances that are surfactants, complexing agents, solvents, preservatives, thickening agents and dissolving agents, bleaching agents, acids and other additives.
Test method
Test results
Reference
C6 Anaerobic degradability and potential for sediment accumulation
Anaerobic degradability must be reported for surfactants and for organic other additives. For organic other additives
for which there is no risk of accumulation in anaerobic environments and which have an adsorption coefficient
below 25% and a desorption coefficient greater than 75%, anaerobic degradability does not need to be reported.
Test method
Test results
Reference
£ There is no risk of the other additive accumulating in anaerobic environments.
Adsorption coefficient
Reference
Desorption coefficient
Reference
C7Bioaccumulation
Bioaccumulability must be reported for organic chemical substances that are preservatives, solvents, thickening agents
and dissolving agents, bleaching agents and other additives.
Bioconcentration factor
Test method
Reference
If no bioconcentration factor is available, the octanol-water-coefficient should be reported.
Log K ow
Reference
C8 Toxicity to aquatic organisms
Data for acute toxicity is reported for surfactants, complexing agents, solvents, preservatives, thickening agents
and dissolving agents, bleaching agents, acids and other additives.
Acute toxicity to fish (mg/l)
Test method
Reference
Acute toxicity to Daphnia (mg/l)
Test method
Reference
Acute toxicity to algae (mg/l)
Test method
Reference
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Form for assessing an ingredient
C9 Raw materials for synthesis and organic halogen compound residues
Raw materials for surfactant synthesis and any content of organic halogen compounds in the surfactant must be reported.
£ Palm oil is not a raw material for surfactant synthesis.
£ Palm oil is a raw material for surfactant synthesis.
Documentation that the manufacturer or its supplier is RSPO-certified:
£ Enclosed with application.
£ Sent from manufacturer.
£ The surfactant contains <100 ppm TOX organic halogen compounds.
C10 Information for colouring agents
£ The colouring agent is approved according to regulation (EC) No 1333/2008.
£ The colouring agent is not classified as H317, May cause an allergic skin reaction.
£ The colouring agent is an azo colouring agent and could potentially be broken down into amines.
If the colouring agent is an azo colouring agent and could potentially be broken down into amines, a list of these must be enclosed with the application. The list must contain all amines and their CAS-numbers.
C11 Safety data sheets
A safety data sheet must be submitted to the Swedish Society for Nature Conservation for the chemical substance
(see REACH regulations for structure).
£ Safety data sheet has been sent to e-mail [email protected]
£ Safety data sheet has been sent by post
Please confirm by signing below that the information in this form is correct.
Location and date
Signature by person authorized to sign for the manufacturer
Name in print
The form should be sent to:
The Swedish Society for Nature Conservation
Norra Allégatan 5
413 01 Göteborg
Sweden
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