R11 Plusby Forbo Flooring Systems

Health ProductDeclaration v2.2

created via: HPDC Online Builder

HPD UNIQUE IDENTIFIER: 26071
CLASSIFICATION: 09 65 19.23 Vinyl Tile Flooring
PRODUCT DESCRIPTION: R-11 Plus is a heavy duty loose lay tile with enhanced slip resistance, categorized as R-11, because of the strong
surface embossed structure. Size: 23.94” x 23.94” (60.8cm x 60.8cm) Gauge: 0.413” (10.5mm) Packaging: 5 pieces per carton (19.89 ft2, 1.790
meters2)

Section 1: Summary

Basic Method / Product Threshold

CONTENT INVENTORY
Inventory Reporting Format

Threshold level

Nested Materials Method
Basic Method
Threshold Disclosed Per

100 ppm
1,000 ppm
Per GHS SDS
OtherMaterialProductResiduals/Impurities
Considered
Partially Considered
Not Considered
Explanation(s) provided
for Residuals/Impurities?
Yes NoAll Substances Above the Threshold Indicated Are:
Characterized
Yes Ex/SC Yes

No% weight and role provided for all substances.
Screened
Yes Ex/SC Yes

NoAll substances screened using Priority Hazard Lists withresults disclosed.
Identified
Yes Ex/SC Yes No
All substances disclosed by Name (Specific or Generic)and Identifier.

CONTENT IN DESCENDING ORDER OF QUANTITY

Number of Greenscreen BM-4/BM3 contents ... 0

Summary of product contents and results from screening individual
chemical substances against HPD Priority Hazard Lists and theGreenScreen for Safer Chemicals®. The HPD does not assess whether
using or handling this product will expose individuals to its chemical
substances or any health risk. Refer to Section 2 for further details.

Contents highest concern GreenScreen
Benchmark or List translator Score ... BM-1

MATERIAL | SUBSTANCE | RESIDUAL OR IMPURITYGREENSCREEN SCORE | HAZARD TYPE

Nanomaterial ... No
INVENTORY AND SCREENING NOTES:Percentage (%) ranges for ingredients are used as a means of keeping
the exact formulations proprietary.

R11 PLUS [ BIS(2-ETHYLHEXYL) TEREPHTHALATE BM-3dg FATTY
ACIDS, C16-18, ZINC SALTS LT-UNK TITANIUM DIOXIDE LT-1 | CAN |END CALCIUM STEARATE LT-UNK PARAFFIN LT-UNK LIMESTONEBM-3dg CARBON BLACK BM-1 | CAN POLYVINYL CHLORIDE LT-P1 |RES ]VOLATILE ORGANIC COMPOUND (VOC) CONTENTVOC Content data is not applicable for this product category.

CERTIFICATIONS AND COMPLIANCE See Section 3 for additionallistings.
VOC emissions: CDPH Standard Method V1.2 (Section 01350/CHPS) Classroom & Office scenario
CONSISTENCY WITH OTHER PROGRAMS
Pre-checked for LEED v4 Material Ingredients Option 1Third Party Verified?
Yes
No

R11 Plus
hpdrepository.hpd-collaborative.org

PREPARER: Self-Prepared
VERIFIER:
VERIFICATION #:SCREENING DATE: 2021-09-13
PUBLISHED DATE: 2021-09-13
EXPIRY DATE: 2024-09-13

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Section 2: Content in Descending Order of Quantity
This section lists contents in a product based on specific threshold(s) and reports detailed health information including hazards. This HPD uses theinventory method indicated above, which is one of three possible methods:
Basic Inventory method with Product-level threshold.
Nested Material Inventory method with Product-level threshold
Nested Material Inventory method with individual Material-level thresholds
Definitions and requirements for the three inventory methods and requirements for each data field can be found in the HPD Open Standard version
2.2, available on the HPDC website at: www.hpd-collaborative.org/hpd-2-2-standard

R11 PLUS
PRODUCT THRESHOLD: 1000 ppm

RESIDUALS AND IMPURITIES CONSIDERED: No

RESIDUALS AND IMPURITIES NOTES: No residuals or impurities are expected to be present in the product at or above the reporting threshold.
OTHER PRODUCT NOTES: N/A
ID: 6422-86-2

BIS(2-ETHYLHEXYL) TEREPHTHALATEHAZARD SCREENING METHOD: Pharos Chemical and Materials Library

HAZARD SCREENING DATE: 2021-09-13 16:55:11%: 4.0000

RC: None

GS: BM-3dg

HAZARD TYPEAGENCY AND LIST TITLES

NANO: NoSUBSTANCE ROLE: BinderWARNINGS

None foundNo warnings found on HPD Priority Hazard Lists

SUBSTANCE NOTES: Also used in the Colorex recycled scrap (scrap used as binder, 0.1% - 94%).

ID: 91051-01-3

FATTY ACIDS, C16-18, ZINC SALTS
HAZARD SCREENING METHOD: Pharos Chemical and Materials Library

HAZARD SCREENING DATE: 2021-09-13 16:55:12%: 0.1000 - 1.0000

GS: LT-UNK

RC: NoneHAZARD TYPEAGENCY AND LIST TITLES

NANO: NoSUBSTANCE ROLE: Processing regulator

WARNINGS

None foundNo warnings found on HPD Priority Hazard Lists

SUBSTANCE NOTES: Also used in the Colorex recycled scrap (scrap used as binder, 0.1% - 94%).

ID: 13463-67-7

TITANIUM DIOXIDEHAZARD SCREENING METHOD: Pharos Chemical and Materials Library

HAZARD SCREENING DATE: 2021-09-13 16:55:12%: 0.1000 - 94.0000

RC: None

R11 Plus
hpdrepository.hpd-collaborative.org

GS: LT-1

NANO: NoSUBSTANCE ROLE: Binder

HPD v2.2 created via HPDC Builder Page 2 of 6HAZARD TYPEAGENCY AND LIST TITLESWARNINGSCANUS CDC - Occupational Carcinogens

Occupational Carcinogen

CAN

CA EPA - Prop 65Carcinogen - specific to chemical form or exposure route

CAN

IARC

Group 2B - Possibly carcinogenic to humans - inhaledfrom occupational sources

CAN

MAKCarcinogen Group 3A - Evidence of carcinogenic effects
but not sufficient to establish MAK/BAT value

END

TEDX - Potential Endocrine Disruptors

Potential Endocrine Disruptor

CAN

MAK

Carcinogen Group 4 - Non-genotoxic carcinogen with low
risk under MAK/BAT levels

CAN

EU - GHS (H-Statements)

H351 - Suspected of causing cancer [Carcinogenicity Category 2]

SUBSTANCE NOTES: Recycled Colorex scrap. The titanium dioxide (TiO2) is bound within the product, requiring no further labeling. Identified
on the US EPA Safer Chemical Ingredient List. Form-specific hazards: airborne particles of respirable size – occupational setting. Specificguidelines are being created to address known issues related to transparency and disclosure for several materials (“Special Conditions”),including those with Form-Specific Hazards such as Titanium Dioxide. This HPD will be updated as appropriate when these guidelines becomeavailable. The Material Health Harmonization Task Group convened by the USGBC states that pigmentary titanium dioxide was "determined tobe Benchmark 2 using the full GS (GreenScreen) method” hpdrepository.hpd-collaborative.org HPD v2.1 created via HPDC Builder Page 2 of
12 (http://ow.ly/Z5ken).

ID: 1592-23-0

CALCIUM STEARATEHAZARD SCREENING METHOD: Pharos Chemical and Materials Library

HAZARD SCREENING DATE: 2021-09-13 16:55:13%: 0.1000 - 1.0000

GS: LT-UNK

RC: NoneHAZARD TYPEAGENCY AND LIST TITLES

NANO: NoSUBSTANCE ROLE: Processing regulator

WARNINGS

None foundNo warnings found on HPD Priority Hazard Lists

SUBSTANCE NOTES: Also used in the Colorex recycled scrap (scrap used as binder, 0.1% - 94%).

ID: 8002-74-2

PARAFFIN
HAZARD SCREENING METHOD: Pharos Chemical and Materials Library

HAZARD SCREENING DATE: 2021-09-13 16:55:13%: 0.1000 - 1.0000

GS: LT-UNK

RC: NoneHAZARD TYPEAGENCY AND LIST TITLES

NANO: NoSUBSTANCE ROLE: Processing regulator

WARNINGS

None foundNo warnings found on HPD Priority Hazard Lists

SUBSTANCE NOTES: Also used in the Colorex recycled scrap (scrap used as binder, 0.1% - 94%).

ID: 1317-65-3

LIMESTONE
HAZARD SCREENING METHOD: Pharos Chemical and Materials Library

HAZARD SCREENING DATE: 2021-09-13 16:55:13%: 0.1000 - 94.0000

RC: None

R11 Plus
hpdrepository.hpd-collaborative.org

GS: BM-3dg

NANO: NoSUBSTANCE ROLE: Binder

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HAZARD TYPEAGENCY AND LIST TITLESWARNINGS

None foundNo warnings found on HPD Priority Hazard Lists

SUBSTANCE NOTES: Recycled Colorex scrap.

ID: 1333-86-4

CARBON BLACK
HAZARD SCREENING METHOD: Pharos Chemical and Materials Library

HAZARD SCREENING DATE: 2021-09-13 16:55:14%: 0.1000 - 1.9900

RC: None

GS: BM-1

NANO: NoSUBSTANCE ROLE: Pigment

HAZARD TYPEAGENCY AND LIST TITLESWARNINGSCANUS CDC - Occupational Carcinogens

Occupational Carcinogen

CAN

MAK

Carcinogen Group 3B - Evidence of carcinogenic effects
but not sufficient for classificationCAN

CA EPA - Prop 65

Carcinogen - specific to chemical form or exposure route

CAN

IARC

Group 2B - Possibly carcinogenic to humans - inhaledfrom occupational sources

SUBSTANCE NOTES: Also used in the Colorex recycled scrap (scrap used as binder, 0.1% - 94%).

ID: 9002-86-2

POLYVINYL CHLORIDEHAZARD SCREENING METHOD: Pharos Chemical and Materials Library

HAZARD SCREENING DATE: 2021-09-13 16:55:14%: 0.0100 - 94.0000

RC: None

GS: LT-P1

NANO: NoSUBSTANCE ROLE: Binder

HAZARD TYPEAGENCY AND LIST TITLESWARNINGSRESAOEC - Asthmagens

Asthmagen (Rs) - sensitizer-induced

SUBSTANCE NOTES: Recycled Colorex scrap.

R11 Plus
hpdrepository.hpd-collaborative.org

HPD v2.2 created via HPDC Builder Page 4 of 6Section 3: Certifications and ComplianceThis section lists applicable certification and standards compliance information for VOC emissions and VOC content. Other types of health orenvironmental performance testing or certifications completed for the product may be provided.

VOC EMISSIONSCDPH Standard Method V1.2 (Section 01350/CHPS) - Classroom & Office scenario

CERTIFYING PARTY: Third Party
APPLICABLE FACILITIES: All
CERTIFICATE URL:

ISSUE DATE: 2017-0723

EXPIRY DATE:CERTIFIER OR LAB: Berkeley
Analytics

CERTIFICATION AND COMPLIANCE NOTES:

Section 4: Accessories
This section lists related products or materials that the manufacturer requires or recommends for installation (such as adhesives or fasteners),
maintenance, cleaning, or operations. For information relating to the contents of these related products, refer to their applicable Health ProductDeclarations, if available.

FORBO WALL BASE

HPD URL: http://www.forboflooringna.com

CONDITION WHEN RECOMMENDED OR REQUIRED AND/OR OTHER NOTES:Can be used with the R11 Plus installation using the recommended adhesive.

R11 PLUS RAMP

HPD URL: No HPD available

CONDITION WHEN RECOMMENDED OR REQUIRED AND/OR OTHER NOTES:Can be used with the R11 Plus installation.

Section 5: General Notes
R11 Plus contains no Isocyanates.

R11 Plus
hpdrepository.hpd-collaborative.org

HPD v2.2 created via HPDC Builder Page 5 of 6

Section 6: References
MANUFACTURER INFORMATIONMANUFACTURER: Forbo Flooring Systems
ADDRESS: 8 Maplewood Drive
Hazle Township PA 18202, United States
WEBSITE: http://www.forboflooringna.com

CONTACT NAME: Shannon Wolski-Konecnik
TITLE: Product Support and Education Services Administrator
PHONE: 5704500319
EMAIL: shannon.wolski@forbo.com

The listed contact is responsible for the validity of this HPD and attests that it is accurate and complete to the best of his or her knowledge.
KEYHazard Types
AQU Aquatic toxicity
CAN Cancer
DEV Developmental toxicity
END Endocrine activity
EYE Eye irritation/corrosivity
GEN Gene mutation
GLO Global warming

LAN Land toxicity
MAM Mammalian/systemic/organ toxicity
MUL Multiple
NEU Neurotoxicity
NF Not found on Priority Hazard Lists
OZO Ozone depletionPBT Persistent, bioaccumulative, and toxic

PHY Physical hazard (flammable or reactive)
REP Reproductive
RES Respiratory sensitization
SKI Skin sensitization/irritation/corrosivity
UNK Unknown

GreenScreen (GS)BM-4 Benchmark 4 (prefer-safer chemical)
BM-3 Benchmark 3 (use but still opportunity for improvement)
BM-2 Benchmark 2 (use but search for safer substitutes)
BM-1 Benchmark 1 (avoid - chemical of high concern)
BM-U Benchmark Unspecified (due to insufficient data)
LT-P1 List Translator Possible 1 (Possible Benchmark-1)

LT-1 List Translator 1 (Likely Benchmark-1)
LT-UNK List Translator Benchmark Unknown (the chemical ispresent on at least one GreenScreen Specified List, but theinformation contained within the list did not result in a clear mapping
to a LT-1 or LTP1 score.)
NoGS No GreenScreen.

Recycled Types
PreC Pre-consumer recycled content
PostC Post-consumer recycled content
UNK Inclusion of recycled content is unknown
None Does not include recycled content
Other Terms:
GHS SDS Globally Harmonized System of Classification and Labeling of Chemicals Safety Data Sheet
Inventory Methods:
Nested Method / Material Threshold Substances listed within each material per threshold indicated per material
Nested Method / Product Threshold Substances listed within each material per threshold indicated per productBasic Method / Product Threshold Substances listed individually per threshold indicated per productNano Composed of nano scale particles or nanotechnology
Third Party Verified Verification by independent certifier approved by HPDC
Preparer Third party preparer, if not self-prepared by manufacturer
Applicable facilities Manufacturing sites to which testing applies

The Health Product Declaration (HPD) Open Standard provides for the disclosure of product contents and potential associated human andenvironmental health hazards. Hazard associations are based on the HPD Priority Hazard Lists, the GreenScreen List Translator™, and whenavailable, full GreenScreen® assessments. The HPD Open Standard v2.1 is not:a method for the assessment of exposure or risk associated with product handling or use,a method for assessing potential health impacts of: (i) substances used or created during the manufacturing process or (ii) substances createdafter the product is delivered for end use.
Information about life cycle, exposure and/or risk assessments performed on the product may be reported by the manufacturer in appropriate Notes
sections, and/or, where applicable, in the Certifications section.
The HPD Open Standard was created and is supported by the Health Product Declaration Collaborative (the HPD Collaborative), a customer-led
organization composed of stakeholders throughout the building industry that is committed to the continuous improvement of building products
through transparency, openness, and innovation throughout the product supply chain.
The product manufacturer and any applicable independent verifier are solely responsible for the accuracy of statements and claims made in this HPD
and for compliance with the HPD standard noted.

R11 Plus
hpdrepository.hpd-collaborative.org

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