Below you will find an Adobe pdf file of the Shipper’s Declaration for Dangerous Goods. Four copies of the declaration must be provided for all packages containing dangerous goods. This is mandated by DOT and IATA. Please see the Disclaimer and Instructions below.

Shipper's Declaration For Dangerous Goods Form PDF (Color printer required)

For people without a color printer, red striped paper must be used when printing this completed from. The paper is available from Central Receiving at 1-5347.

Red Lined Paper Required Shipper's Declaration For Dangerous Goods Form PDF

If you have any questions please contact: Central Receiving @ 1-5347

DISCLAIMER

Proper training is required under federal and/or state regulations to handle dangerous goods and/or hazardous material  All persons and entities must comply with all federal regulations, including but not limited to the specific training requirements of 49 C.F.R. (172.704)

Central Receiving provides these materials as a service, to be used as guidelines to assist properly trained shippers.  The materials provided by Central Receiving in no way alter, satisfy, or influence any federal or state requirements.  The attached information provided does not meet training requirements as required in DOT 49 CFR.

The study and/or use of these materials does not qualify an individual to prepare, package, transport, or otherwise handle dangerous goods or hazardous material.

The information contained in this document is subject to change or update due to changing government regulations.  The user of this document assumes responsibility for complying with all applicable laws and regulations regarding the shipment of Dangerous Goods.

INSTRUCTIONS
FOR COMPLETING THE SHIPPERS DECLARATION

Step 1
Open the Attached Shipper’s Declaration with Adobe Acrobat Reader.  ( Adobe Acrobat Reader is available as a free download from the Adobe.com Website.)

Step 2
Save a blank copy of the Shipper’s Declaration form for future use.  (form must be computer generated or typed.)

Step 3
Begin by placing the cursor in the “Shipper” block in the upper left corner of the Shippers Declaration and keying information as appropriate.  Using the  Mouse  to move from one field to the next, complete all fields.         For a detailed explanation of information required on a Shipper’s Declaration,  Refer to IATA Section 8 – Documentation ( Paragraph 8.1.6).  A general explanation of how to complete the attached  form is provided below:

• Shipper – Full name and address of the shipper including phone #
• Air Waybill Number – The number of the Air Waybill to which the declaration form will be attached.  (obtain Waybill  before completing this section.)
• Page of pages – The page number and the total number of pages ( For a single page Shipper’s Declaration, enter “Page 1 of 1 pages”).
• Shipper’s Reference Number – Fund # being used for the shipping cost.
• Consignee – Full name and address of recipient, including phone #.
• Transport Details – Click to the appropriate field, and using the capital “X,” enter X’s to block out “Passenger and Cargo Aircraft” (for shipments which must travel on Cargo Aircraft Only) or to block out “Cargo Aircraft Only” (for shipments which may travel on either Passenger or Cargo aircraft). (see drop down provided on this form)
• Airport of Departure – Enter the full name of the airport or city of departure.  (For a package being shipped out of Denver using Denver International Airport, this field may be completed as: “Denver,” “Denver International Airport,” “DIA,” “Denver, Colorado,” etc.).
• Airport of Destination – Enter the full name of the airport or city of destination. (For a package being shipped to Denver using Denver International Airport, this field may be completed as: “Denver,” “Denver International Airport,” “DIA,” “Denver, Colorado,” etc.).
• Shipment Type – Click to the appropriate field, and using the capital letter “X,” enter X’s to block out “Non-Radioactive” (for shipments which contain radioactive material) or block out “Radioactive” (for shipments that do not contain radioactive material). (see drop down provided on this form)
• Nature and Quantity of Dangerous Goods – Enter the required information strictly in accordance with IATA 8.1.6.9.  Begin by entering the UN or ID Number.                              
  Per IATA 8.1.6.10 (b), the information in this field “must be entered in sequence within the columns provided.”  If your information will not fit without going over the lines separating the columns, use the ENTER key and enter text on another line.
• Additional Handling Information – Enter any special handling information relevant to the shipment in accordance with IATA 8.1.6.11.
• Emergency Telephone Number – All dangerous goods shipments to, from, within, or transiting through the U.S. must include 24-hour emergency response information as described in IATA 2.9.2, USG-12.
• Name and title of Signatory – Enter the name and title of the person actually signing the Shipper’s Declaration.  Place and Date – Enter the place and date to indicate where and when the form is actually signed.

Step 4
Print and sign the form. Per IATA 8.1.4.1, a typewritten signature is not acceptable.

Step 5
Provide four (4) signed copies of the complete Shipper’s Declaration (with diagonal hatchings printed in red) to carrier for shipping.