Ethylene Glycol: Systemic Agent

APPEARANCE: Clear, colorless, syrupy (viscous) liquid at room temperature. Often colored fluorescent yellow-green when used in automotive antifreeze.

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DESCRIPTION: Ethylene glycol is a useful industrial compound found in many consumer products. Examples include antifreeze, hydraulic brake fluids, some stamp pad inks, ballpoint pens, solvents, paints, plastics, films, and cosmetics. It can also be a pharmaceutical vehicle. Ethylene glycol has a sweet taste và is often ingested by accident or on purpose. Ethylene glycol breaks down into toxic compounds in the body. Ethylene glycol and its toxic byproducts first affect the central nervous system (CNS), then the heart, and finally the kidneys. Ingesting enough can cause death. Ethylene glycol is odorless.METHODS OF SPREADING:Indoor Air: Ethylene glycol can release into indoor air as a liquid spray (aerosol), vapor, or mist.Water: Ethylene glycol can pollute water.Food: Ethylene glycol can pollute food.Outdoor Air: Ethylene glycol can release into outdoor air as a liquid spray (aerosol), vapor, or mist.Agricultural: If ethylene glycol releases as a liquid spray (aerosol) or mist, it may pollute agricultural products. If ethylene glycol releases as a vapor, it is unlikely khổng lồ pollute agricultural products.ROUTES OF EXPOSURE: Systemic ethylene glycol toxicity can occur through ingestion. Breathing ethylene glycol vapors may irritate eyes and lungs but is unlikely to lớn cause systemic toxicity. Ethylene glycol does not absorb well through the skin so systemic toxicity is unlikely. Eye exposure may lead to local adverse health effects but is unlikely to lớn result in systemic toxicity.
GENERAL INFORMATION: First Responders should use a NIOSH-certified Chemical, Biological, Radiological, Nuclear (CBRN) Self Contained Breathing Apparatus (SCBA) with a màn chơi A protective suit. Responders should wear these when entering an area with an unknown contaminant or when entering an area where the amount of the contaminant is unknown. Level A protection is necessary until monitoring results confirm the contaminant & the amount of the contaminant.NOTE: Safe use of protective clothing và equipment requires specific skills from training và experience.LEVEL A: (RED ZONE): Select this màn chơi when workers need the greatest cấp độ of skin, respiratory, and eye protection. This is the maximum protection for workers in danger of exposure lớn unknown chemical hazards or levels above the IDLH or greater than the AEGL-2.A NIOSH-certified CBRN full-face-piece SCBA operated in a pressure-demand mode or a pressure-demand supplied air hose respirator with an auxiliary escape bottle.A Totally-Encapsulating Chemical Protective (TECP) suit that protects against CBRN agents.Chemical-resistant gloves (outer).Chemical-resistant gloves (inner).Chemical-resistant boots with a steel toe và shank.Optional items: Coveralls, long underwear, and a hard hat worn under the TECP suit.LEVEL B: (RED ZONE): Select this level when workers need the highest cấp độ of respiratory protection but a lower màn chơi of skin protection. This is the minimum protection for workers in danger of exposure khổng lồ unknown chemical hazards or levels above the IDLH or greater than AEGL-2. It includes a non-encapsulating, splash-protective, chemical-resistant splash suit that provides màn chơi A protection against liquids but is not airtight.A NIOSH-certified CBRN full-face-piece SCBA operated in a pressure-demand mode or a pressure-demand supplied air hose respirator with an auxiliary escape bottle.A hooded chemical-resistant suit that protects against CBRN agents.Chemical-resistant gloves (outer).Chemical-resistant gloves (inner).Chemical-resistant boots with a steel toe and shank.Optional items: Coveralls, long underwear, a hard hat worn under the chemical-resistant suit, và chemical-resistant disposable boot-covers worn over the chemical-resistant suit.LEVEL C: (YELLOW ZONE): Select this cấp độ when: 1) workers know the contaminant và the amount present 2) when meeting the respiratory protection criteria factors for using Air Purifying Respirators (APR) or Powered Air Purifying Respirators (PAPR). This cấp độ is appropriate when decontaminating patient/victims.A NIOSH-certified CBRN tight-fitting APR with a canister-type gas mask or CBRN PAPR for air levels greater than AEGL-2.A NIOSH-certified CBRN PAPR with a loose-fitting face-piece, hood, or helmet. It should include a filter or a combination organic vapor, acid gas, and particulate cartridge/filter combination or a continuous flow respirator for air levels greater than AEGL-1.A hooded chemical-resistant suit that protects against CBRN agents.Chemical-resistant gloves (outer).Chemical-resistant gloves (inner).Chemical-resistant boots with a steel toe & shank.Optional items: Escape mask, face shield, coveralls, long underwear, a hard hat worn under the chemical-resistant suit, & chemical-resistant disposable boot-covers worn over the chemical-resistant suit.LEVEL D: (GREEN ZONE): Select this màn chơi when workers know the contaminant and the amount present. Select when the amount is below the appropriate occupational exposure limit or less than AEGL-1 for the stated duration times.Limited to lớn coveralls or other work clothes, boots, và gloves.
CHEMICAL DANGERS:Ethylene glycol reacts with strong oxidants & acids.EXPLOSION HAZARDS:Lower explosive (flammable) limit in air (LEL): 3.2%. Upper explosive (flammable) limit in air (UEL): 15.3%.FIRE FIGHTING INFORMATION:Ethylene glycol is combustible.Extinguish fires using an agent suitable for the type of surrounding fire.Use “alcohol” foam, dry chemical, or carbon dioxide.Keep run-off water out of sewers và water sources.INITIAL ISOLATION & PROTECTIVE action DISTANCES:Isolate tanks, rail cars, or tank trucks involved in fires for 0.5 ngươi (800 m) in all directions. Also consider initial evacuation for 0.5 mày (800 m) in all directions.This agent is not listed in the DOT ERG 2004 Table of Initial Isolation và Protective action Distances.Immediately isolate an ethylene glycol spill or leak area for at least 330 ft (100 m) in all directions. This và other public safety actions are listed in the DOT ERG 2004 orange-bordered section of the guidebook (Guide 111).PHYSICAL DANGERS:Vapors are heavier than air and will collect in poorly ventilated, low-lying, or confined areas (e.g., sewers, basements, và tanks).Hazardous amounts may develop quickly in enclosed, poorly ventilated, or low-lying areas. Keep out of these areas & upwind.NFPA 704 Signal:
Health: 1Flammability: 1Reactivity: 0Special:

References are provided for the convenience of the reader and do not imply endorsement by NIOSH.
AIR MATRIXBost RO, Sunshine I < 1980>. Ethylene-glycol analysis by gas-chromatography. J Anal Toxicol 4(2):102-103.Cao XL, Zhu J <2001>. Monitoring method for airborne glymes and its application in fuel exhaust emission measurement. Chemosphere 45(6-7):911-917.NIOSH <1996>. NMAM 5523, Issue 1: Glycols. In: NIOSH Manual of analytical methods. 4th ed. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety & Health, DHHS (NIOSH) Publication No. 94-113.Pendergrass SM <1999>. Determination of glycols in air: development of sampling & analytical methodology & application to lớn theatrical smokes. Am Ind Hyg Assoc J 60:452-457.Potter W <1999>. Ethylene glycol Method PV2024. OSHA Salt Lake City, UT: U.S. Department of Labor, OSHA Salt Lake Technical Center, Chromatography Team.OTHERNo references were identified for this sampling matrix for this agent.SOIL MATRIXDavidsen JM, Grypa RD <1995>. Gas chromatographic methods for the determination of ethylene oxide and its reaction products in spices và herbs . 210th American Chemical Society National Meeting, Chicago, Illinois, August 20-24.SURFACESNo references were identified for this sampling matrix for this agent.WATERHouz? P, Chaussard J <1993>. Simultaneous determination of ethylene glycol, propylene glycol, 1,3-butylene glycol & 2,3-butylene glycol in human serum and urine by wide-bore column gas chromatography. J Chromatogr B: Biomed Appl 619(2):251-257.Kenyon AS, Shi X, Wang Y, Ng WH, Prestridge R, Sharp K <1998>. Simple, at-site detection of diethylene glycol/ethylene glycol contamination of glycerin & glycerin- based raw materials by thin-layer chromatography. J AOAC Int 81(1):44-50.Maurer HH, Peters FT, Paul LD, Kraemer T <2001>. Validated gas chromatographic–mass spectrometric assay for determination of the antifreezes ethylene glycol và diethylene glycol in human plasma after microwave-assisted pivalylation. J Chromatogr B: Biomed Appl 754(2):401-409.Nilsson L, Jones AW <1992>. 2,3-Butanediol: A potential interfering substance in the assay of ethylene glycol by an enzymatic method. Clin Chim Acta 208(3):225-229.Oudhoff KA, Schoenmakers PJ, Kok WT <2003>. Characterization of polyethylene glycols & polypropylene glycols by capillary zone electrophoresis và micellar electrokinetic chromatography. J Chromatogr A 985(1-2):479-491.Szymanski A, Wyrwas B, Szymanowska M, Lukaszewski Z <2001>. Determination of short-chained poly(ethylene glycols) and ethylene glycol in environmental samples. Water Res 35(15):3599-3604.Wahl A, Azaroual N, Imbenotte M, Mathieu D, Forzy G, Cartigny B, Vermeersch G, Lhermitte M <1998>. Poisoning with methanol và ethylene glycol: 1H NMR spectroscopy as an effective clinical tool for diagnosis và quantification. Toxicology 128(1):73-81.
TIME COURSE: After ingestion, ethylene glycol rapidly absorbs (within 1 to lớn 4 hours) through the stomach. Following absorption, 80% or more of ethylene glycol chemically converts into toxic compounds. Ethylene glycol toxicity is categorized into three broad overlapping stages of adverse health effects. Stage 1 (the neurological stage) lasts from 30 minutes to lớn 12 hours after ingestion. Stage 2 (the cardiopulmonary stage) occurs between 12 & 24 hours after ingestion. Stage 3 (the renal stage) occurs between 24 và 72 hours after ingestion. The co-ingestion of alcohol can significantly delay adverse health effects.EFFECTS OF SHORT-TERM (LESS THAN 8-HOURS) EXPOSURE: Early ethylene glycol intoxication is like ethanol intoxication but there is no odor of alcohol on the patient/victim’s breath. Initial adverse health effects caused by ethylene glycol intoxication include:central nervous system depression,intoxication,euphoria,stupor, andrespiratory depression.Nausea & vomiting may occur as a result of gastrointestinal irritation.Severe toxicity may result in coma, loss of reflexes, seizures (uncommon), & irritation of the tissues lining the brain.

The toxic metabolic by-products of ethylene glycol metabolism cause a build-up of acid in the blood. This process is called metabolic acidosis. These toxic substances also affect the cardiopulmonary system & can cause renal failure. Metabolic acidosis commonly occurs after ethylene glycol intoxication, but absence of acidosis does not exclude ethylene glycol toxicity. Serum ethylene glycol levels vày not correlate well with clinical presentation.Untreated ethylene glycol poisoning can be fatal.

EYE EXPOSURE:Exposure to vapors of ethylene glycol may cause irritation.Exposure to lớn liquid ethylene glycol may result in swelling of the eyelid và cornea, swelling of the conjunctiva & iris, và conjunctival or corneal injury.INGESTION EXPOSURE:Mild to moderate, Stage 1: Reduced cấp độ of consciousness (CNS depression), euphoria, dizziness, headache, slurred speech, drowsiness, disorientation, inability to coordinate movements (ataxia), irritation & restlessness, involuntary eye movements (nystagmus), & nausea & vomiting (emesis).Mild lớn moderate, Stage 2: Increased heart rate (tachycardia); abnormal or disordered heart rhythms (dysrhythmia); increased blood pressure (hypertension); & build-up of toxic breakdown products in the blood stream (metabolic acidosis), resulting in increased rate & depth of breathing (hyperventilation).Mild lớn moderate, Stage 3: Effects are unusual following a mild lớn moderate exposure.Severe, Stage 1: Decreased reflex responses, seizures, loss of consciousness, and coma.Severe, Stage 2: More severe build-up of toxic breakdown products in the blood stream, resulting in increased rate và depth of breathing; heart damage, including congestive heart failure, resulting in buildup of fluid in the lungs (pulmonary edema); lung damage, including adult respiratory distress syndrome (ARDS), resulting in a decreased oxygen supply to lớn the body; multi-system organ failure; and death.Severe, Stage 3: Reduced urine excretion; absence of urine excretion; và acute kidney failure, causing a build-up of toxic chemicals & chemical imbalances in the blood stream.INHALATION EXPOSURE:Exposure khổng lồ very high levels of ethylene glycol vapors causes irritation of mucous membranes và the upper respiratory tract.Exposure khổng lồ levels of ethylene glycol concentrations higher than 80 ppm results in intolerable respiratory discomfort & cough.

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INTRODUCTION: The purpose of decontamination is to lớn quickly and effectively remove toxic substances for the safety of an individual and/or their equipment. Decontaminate carefully because absorbed agent can release from clothing and skin as a gas. Your Incident Commander will provide you with decontaminants specific for the agent released or the agent believed to lớn have been released.DECONTAMINATION CORRIDOR: The following are recommendations to protect the first responders from the release area:Position the decontamination corridor upwind & uphill of the hot zone. The warm zone should include two decontamination corridors. One decontamination corridor is used lớn enter the warm zone & the other for exiting the warm zone into the cold zone. The decontamination zone for exiting should be upwind & uphill from the zone used lớn enter.Decontamination area workers should wear appropriate PPE. See the PPE section of this thẻ for detailed information.A solution of detergent & water with a pH value of at least 8 but not higher than 10.5 should be available for decontamination procedures. Soft brushes should be available lớn remove contamination from the PPE. Labeled, durable 6-mil polyethylene bags should be available for disposal of contaminated PPE.INDIVIDUAL DECONTAMINATION: The following methods can be used lớn decontaminate an individual:Decontamination of First Responder:Begin washing PPE of the first responder using soap & water solution and a soft brush. Always move in a downward motion (from head lớn toe). Make sure to lớn get into all areas, especially folds in the clothing. Wash and rinse (using cold or warm water) until the contaminant is thoroughly removed.Remove PPE by rolling downward (from head to lớn toe) and avoid pulling PPE off over the head. Remove the SCBA after other PPE is removed.Place all PPE in labeled durable 6-mil polyethylene bags.Decontamination of Patient/Victim:Remove the patient/victim from the contaminated area và into the decontamination corridor.Remove all clothing (at least down khổng lồ their undergarments) & place the clothing in a labeled durable 6-mil polyethylene bag.Thoroughly wash & rinse the contaminated skin of the patient/victim using a soap & water solution with cold or warm water. Be careful not lớn break the patient/victim’s skin during the decontamination process, và cover all open wounds.Cover the patient/victim khổng lồ prevent shock and loss of body heat.Move the patient/victim lớn an area where emergency medical treatment is available.
GENERAL INFORMATION: Initial treatment is primarily supportive. In the case of a large ingestion:Treatment under a physician’s direction within the first 30 to lớn 60 minutes should include an attempt to lớn aspirate stomach contents.As ethylene glycol absorbs rapidly from the gastrointestinal (GI) tract, gastric aspiration by use of a nasogastric tube may be useful.ANTIDOTE: Fomepizole và ethanol are effective antidotes against ethylene glycol toxicity. Administer fomepizole or ethanol as soon as possible once the patient/victim is admitted khổng lồ a medical care facility. See Long Term Implications: Medical Treatment for further instruction.EYE:Immediately remove the patient/victim from the source of exposure.Immediately wash eyes with large amounts of tepid water for at least 15 minutes.Seek medical attention immediately.INGESTION:Immediately remove the patient/victim from the source of exposure.Ensure that the patient/victim has an unobstructed airway.Do not induce vomiting (emesis).Treat seizures with diazepam under a physician’s direction or per local EMS protocol.Monitor heart function. Evaluate for low blood pressure (hypotension), abnormal heart rhythms (dysrhythmias), & reduced respiratory function (respiratory depression).Evaluate for low blood sugar (hypoglycemia), electrolyte disturbances, và low oxygen levels (hypoxia).Seek medical attention immediately.INHALATION:Immediately remove the patient/victim from the source of exposure.Evaluate respiratory function and pulse.Ensure that the patient/victim has an unobstructed airway.If shortness of breath occurs or breathing is difficult (dyspnea), administer oxygen.Assist ventilation as required. Always use a barrier or bag-valve-mask device.If breathing has ceased (apnea), provide artificial respiration.Seek medical attention immediately.SKIN:Immediately remove the patient/victim from the source of exposure.See the Decontamination section for patient/victim decontamination procedures.Seek medical attention immediately.
See ATSDR Medical Management Guidelines for Acute Chemical Exposures, Ethylene Glycol,, for detailed recommendations.
MEDICAL TREATMENT:For large ingestions of ethylene glycol, attempt khổng lồ aspirate stomach (gastric) contents using a nasogastric tube, if possible within the first 30 to lớn 60 minutes. In all patient/victims with known or suspected ethylene glycol poisoning, perform the following tests:Blood tests (CBC, blood glucose, serum electrolytes, magnesium, calcium, BUN, creatinine, lactate, ethylene glycol level, and ethanol level)Arterial blood gas (ABG) levels và osmolarityUrinalysis.Repeat these tests as necessary lớn closely monitor the progression of toxic effects. Contact a medical toxicologist or a regional poison control center for assistance in evaluating the anion và osmolar gaps và to decide whether antidotal therapy, intravenous sodium bicarbonate, or hemodialysis is needed.Administer antidotes fomepizole or ethanol intravenously as soon as possible lớn block the conversion of ethylene glycol to lớn formic acid và prevent acidosis.Fomepizole is preferred as its efficacy & safety have been demonstrated, and its therapeutic dose is more easily maintained. Once the patient/victim has become acidotic, administration of fomepizole or ethanol may not provide much benefit, but can be administered at the discretion of the physician in charge.Administer folinic acid (leucovorin) intravenously khổng lồ increase the rate at which formate is metabolized into less toxic chemicals.Hemodialysis is the most effective size of treatment for an acidotic patient/victim. Hemodialysis may be used when the blood ethylene glycol level is greater than 50 mg/dL, with severe metabolic or fluid abnormalities despite other therapeutic interventions, or in cases of kidney failure.Caution: Ethanol and fomepizole dosing must be adjusted during hemodialysis. Thiamine and pyridoxine facilitate a more rapid metabolism of ethylene glycol khổng lồ non-toxic metabolites & should be given as a single dose IV (100 mg daily).DELAYED EFFECTS OF EXPOSURE: Kidney (renal) failure can occur 24 lớn 72 hours after acute ethylene glycol ingestion. Some loss of kidney function may be permanent. In the absence of improvement of renal function, the patient/victim may die or require permanent hemodialysis. Injury lớn the nerves of the head & neck (cranial nerve palsies) may be of short-term or long-term duration. This may affect the nerves that control facial movement, eye movement & vision, hearing, and swallowing. Loss of the ability lớn move a body part (palsy) may occur 4 lớn 18 days post exposure in patient/victims with delayed, inadequate, or no treatment. Brain swelling (cerebral edema) causes an impaired cấp độ of consciousness. This may cause generalized seizures, brain death, or permanent brain damage. Accumulation of fluid in the lungs (pulmonary edema), due to heart or lung damage, may occur. Muscle inflammation (myositis) may occur.EFFECTS OF CHRONIC OR REPEATED EXPOSURE: Ethylene glycol is not classifiable as a human carcinogen. Limited studies have not found ethylene glycol lớn be a carcinogen. It is not known whether chronic or repeated exposure lớn ethylene glycol increases the risk of reproductive toxicity or developmental toxicity. Chronic or repeated exposure lớn ethylene glycol may lead to: irritation of the throat, mild headache, low backache, loss of consciousness, và nystagmus. These will resolve if the source of exposure is removed.
INCIDENT SITE:Consult with the Incident Commander regarding the agent dispersed, dissemination method, level of PPE required, location, geographic complications (if any), and the approximate number of remains.Coordinate responsibilities & prepare to enter the scene as part of the evaluation team along with the FBI HazMat Technician, local law enforcement evidence technician, và other relevant personnel.Begin tracking remains using waterproof tags.RECOVERY & ON-SITE MORGUE:Wear PPE until confirming that all remains are free of contamination.Establish a preliminary (holding) morgue.Gather evidence and place it in a clearly labeled waterproof container. Hand any evidence over to lớn the FBI.Remove và tag personal effects.Perform a thorough external evaluation and a preliminary identification check.See the Decontamination section for decontamination procedures.Decontaminate remains before removing from the incident site.
See Guidelines for Mass Fatality Management During Terrorist Incidents Involving Chemical Agents, U.S. Army Soldier & Biological Chemical Command (SBCCOM), November, 2001 for detailed recommendations.
NIOSH REL:Not established / determinedOSHA PEL:Not established/determinedACGIH TLV:Ceiling: 100 mg/m3 (aerosol only)NIOSH IDLH: Not established/determinedDOE TEEL:TEEL-0: 25 mg/m3TEEL-1: 50 mg/m3TEEL-2: 100 mg/m3TEEL-3: 150 mg/m3AIHA ERPG:ERPG-1: Not established/determinedERPG-2: Not established/determinedERPG-3: Not established/determined
Acute Exposure Guidelines5 min10 min30 min1 hr4 hr8 hrAEGL 1(discomfort, non-disabling) – mg/m3AEGL 2(irreversible or other serious, long-lasting effects or impaired ability to escape) – mg/m3AEGL 3(life-threatening effects or death) – mg/m3
Not established/ determinedNot established/ determinedNot established/ determinedNot established/ determinedNot established/ determinedNot established/ determined
Not established/ determinedNot established/ determinedNot established/ determinedNot established/ determinedNot established/ determinedNot established/ determined
Not established/ determinedNot established/ determinedNot established/ determinedNot established/ determinedNot established/ determinedNot established/ determined

ENVIRONMENT/SPILLAGE DISPOSAL: The following methods can help decontaminate the environment/spillage disposal:Do not touch or walk through the spilled agent if at all possible. However, if required, personnel should wear the appropriate PPE during environmental decontamination. See the PPE section of this thẻ for detailed information.Keep combustibles (e.g., wood, paper, and oil) away from the spilled agent. Use water spray to reduce vapors or divert vapor cloud drift. Avoid allowing water runoff to liên hệ the spilled agent.Do not direct water at the spill or the source of the leak.Stop the leak if it is possible to vày so without risk to personnel. Turn leaking containers so that gas escapes instead of liquid.Prevent entry into waterways, sewers, basements, or confined areas.Isolate the area until gas has dispersed.Ventilate the area.EQUIPMENT: Agents can seep into the crevices of equipment making it dangerous khổng lồ handle. The following methods can help decontaminate equipment:Not established/determined
Chemical Formula:C2H6O2Aqueous solubility:SolubleBoiling Point:387°F (197.6°C)Density:Liquid: 1.11 at 68°F (20°C)Vapor: 2.14 (air = 1)Flammability:Combustible liquidFlashpoint:232°F (111°C)Ionization potential:Not established/determinedLog Kbenzene-water:Not established/determinedLog Kow (estimated):-1.36Melting Point:9°F (-13°C)Molecular Mass:62.07Soluble In:Miscible with lower aliphatic alcohols, glycerol, acetic acid, acetone & similar ketones, aldehydes, và pyridine and similar coal tar bases. Slightly soluble in ether. Practically insoluble in benzene và its homologues, chlorinated hydrocarbons, petroleum ether, and oils.Specific Gravity:1.11Vapor Pressure:0.06 milimet Hg at 68°F (20°C)Volatility:Not established/determined
Shipping Name:Not established/determinedIdentification Number:Not established/determinedHazardous Class or Division:Not established/determinedSubsidiary Hazardous Class or Division:Not established/determinedLabel:Not established/determinedPlacard Image:
146AR2-HydroxyethanolAethylenglykol (German)Athylenglykol (German)DowthermDowtherm SR 1Ethane-1,2-diolEthulene DihydrateEthylene alcoholEthylene dihydrateEthylene glycolFridex
glycol alcoholGlycol, ethylene-Lutrol-9Macrogol 400 BPCMEGMonoethylene glycolNorkoolRampTescolUcar 17Union Carbide XL 54 Type I De-Icing FluidZerex

In the sự kiện of a poison emergency, call the poison center immediately at 1-800-222-1222. If the poisoned person cannot wake up, has a hard time breathing, or has convulsions, hotline 911 emergency services.

For information on who to contact in an emergency, see the website at or hotline the public response hỗ trợ tư vấn at (888) 246-2675 (English), (888) 246-2857 (Español), or (866) 874-2646 (TTY).

The user should verify compliance of the cards with the relevant STATE or TERRITORY legislation before use. NIOSH, 2003.

Page last reviewed: October 20, 2021
Content source: National Institute for Occupational Safety and Health (NIOSH)
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