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Stakeholder Identification Form with respect to the Substance Groups Initiative of the Chemicals Management Plan

(PDF Version - 76 KB)

Persons or organizations that have an interest in the substance groups being addressed through the next phase of the Chemicals Management Plan (CMP) may identify themselves as stakeholders for those substances by completing this form. Stakeholders will be informed of future decisions regarding these substances and may be contacted for further information.

Identification

I am interested in being consulted on the following group(s) of substances (please check all that apply):

Name of Person or Organization:
___________________________________________________________________

Federal Business Number (if applicable):
___________________________________________________________________

Address:
___________________________________________________________________

Canadian Head Office Address (if applicable):
___________________________________________________________________

Contact Name (Mr. / Ms. / Dr.):
___________________________________________________________________

Title of Contact:
___________________________________________________________________

Contact Address (if different from Head Office Address):
___________________________________________________________________

Telephone Number:
(_____) _______-____________

Fax Number:
(_____) _______-____________

Email Address: 
___________________________________________________________________

Size of company:

Are you currently a member of a business or trade association? If yes, please specify:
___________________________________________________________________

Type of information in your possession that could help inform the risk assessment and/or risk management, as needed, of the substance groups:
___________________________________________________________________

Please return this form to:

Substances Management Coordinator, Chemical Management Plan
200 Sacré-Coeur Boulevard
Gatineau Quebec K1A 0H3
Fax: 819-953-7155
Email: Substances@ec.gc.ca

Questions? Contact Us:

Substances Management Information Line
Telephone: 1-800-567-1999 or 819-953-7156
Email: Substances@ec.gc.ca

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