Hazard Identification

  • Add chemical in use

  • Chemical
  • undefined

  • State/Figure

  • What is this used for?

  • Location of the process or work where the chemical is used

  • People at Risk

  • other people at risk

  • Hazard

  • Indicate below which route(s) of exposure the substance takes

  • List the risks to health below from exposure to the substance

Containment and Disposal

  • Containment measure and disposal method

Prevention of Hazards

  • Prevention of Hazards

  • Photos of identified hazards and annotations.

Risk Rating

  • Is the exposure adequately controlled?

  • Risk rating after following control measures


  • Recommendations


  • Full Name and Signature of the Inspector

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