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Beryllium Survey

    
 

Please print this page, complete one of the two sections, and mail or fax to Amy Ryder, Ohio Citizen Action, 614 West Superior Avenue, Suite 1200, Cleveland, Ohio 44113 (216) 861-5200, FAX (216) 694-6904. Thank you.

Dental Laboratories

1. Do you currently use beryllium alloys in your laboratory? Yes__ No__

2. If you answered no to question #1, have you ever used beryllium alloys and why did you stop?

3. If you answered yes to question #1, what if any warning did your supplier provide about the health affects of beryllium exposure (for example, what are the warnings on the MSDS)?

4. Are you interested in testing your employees and yourself for possible beryllium exposure to sensitization?

Dentists

1. Do you currently use beryllium alloy products in your practice? Yes__ No__

2. If you answered no to question #1, have you ever used beryllium alloy products and why did you stop?

3. Have you told your dental laboratory they are not to use beryllium in any work they do for you? Yes__ No___

Name of dental lab:___________________________