Information
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Chemical Name
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Manufacturer / Supplier
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Department
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Prepared by
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Conducted on
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Location
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Date of assessment
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Completed by
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People involved in assessment
Chemical Summary
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Manufacturer / Supplier
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Chemical name
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Are we currently using this Chemical? If no, notify Loss Prevention Manager
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Take photo of the chemical
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Is there a current MSDS on the Chemical Register (must be under 5 years old to be current)
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Date of MSDS
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Is the chemical classified as Hazardous or a Dangerous Goods?
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Dangerous Code
- Class 1 Explosives
- Class 2.1 Flammable gases
- Class 2.2 Non flammable and non toxic gases
- Class 2.3 Toxic gas
- Class 3 Flammable liquids
- Class 4.1 Flammable solids
- Class 4.2 Spontaneously combustible
- Class 4.3 Dangerous when wet
- Class 5.1 Oxidising substances
- Class 5.2 Organic peroxides
- Class 6.1 Toxic substances
- Class 6.2 Infectious substance
- Class 7 Radioactive materials
- Class 8 Corrosive substance
- Class 9 Miscellaneous substance
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Check MSDS or click here to check the Chemical on Safe Work Australia's site.
http://hsis.safeworkaustralia.gov.au/HazardousSubstance -
Has a previous Risk Assessment been completed?
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Date of Risk Assessment.
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If the score is 4 or below at this stage no further assessment is required until review of the Chemical in 5 years or it is believed the risk level changes through inspections, incidents, internal reports or internal audits. If you are unsure what risk level to apply continue with the full risk assessment. Add any comments regarding your assessment here.
Chemical Use
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What is the chemical used for?
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What control measures have we put in place when using this Chemical
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What department uses the Chemical
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Engineering
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Housekeeping
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Food & Beverage
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Purchasing
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Administration
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Where is the Chemical stored?
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S-Level - Housekeeping
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P1 Low Storage
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P3 - Engineering
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P2 - Loading Dock
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Where is Chemical used
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Chemical is used - All Areas
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Chemical is used - Rooms / Public Areas
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Chemical is used - Night Cleaner
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Chemical is used - Workshop
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Chemical is used - Gardens
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Chemical is used - Pool / Spa
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Chemical is used - Beverage Store
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Chemical is used - Motion Bar
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Chemical is used - Executive Lounge
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Chemical is used - Main Kitchen
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Chemical is used - Kitchens
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Chemical is used - BBQ's / Gas Heaters
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Chemical is used - Forklift
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Chemical is used - Generator
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Enter amount if over 50 litres
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Enter amount if over 60 mintues
Does the chemical have health hazards?
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Has this Chemical resulted in any internal injury reports or internal hazard reports
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Acute (Immediate) effects
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Eye and skin irritant / Corrosion
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Central Nervous System
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Toxic by inhalation (breathing in)
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Toxic by skin exposure
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Toxic by ingestion (swallowing)
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Other (please detail below)
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Other
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Chronic (Delayed) effects
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Skin / Inhalation effects
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Liver/Kidney effects
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Brain/Nerve effects
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Respiratory effects
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Reproductive System effects
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Carcinogenic (can cause cancer)
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Other (please detail below)
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Other
Does the Chemical have exposure controls or personal protection equipment requirements
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Does the Chemical have exposure standard (ref to the MSDS)(exposure standards are a limit as to the quantity of Chemical one can be exposed to)
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Does the Chemical require health monitoring?
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What PPE is required for the use of the Chemical
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Safety Glasses / goggles
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Safety foot wear
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Face shield
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Overalls
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PVC Apron
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Respirator
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Detail the type of filter required
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Gloves
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Detail the type of gloves required
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Hearing protection
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Is the PPE required being warn? Yes - all the time / Yes - Some, all the time / Some, some of the time / No
Conclusions
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What is the Risk Score out of 55. If the risk score is above 15, suggest reviewing why before making your assessment on the risk and conclusions.
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What are the conclusions about the risk?
- 1 Risk are not significant
- 2 Risk are significant but effectively controlled
- 3 Risks are significant and not adequately controlled
- 4 Uncertain about risks
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If a conclusion of 1 or 2, you have finished the risk assessment. Send to Loss Prevention Manager.<br>If a conclusion of 3 or 4, answer the next question.
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What are you going to do in order to reduce the risk
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Review current control measures
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Put in place new control measures
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Undertake exposure limits (test the air/Chemical levels when the Chemical is being used)
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Training required
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Undertake risk assessment on a yearly basis
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Eliminate / Substitute the Chemical with a acceptable risk
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Seek external advise
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Please sign your name