Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Name of Substance
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CAS No: (if applicable)
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How is the substance used?
Exposure
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How are people exposed to the substance? (Select all applicable)
- Skin (splash or absorbed)
- Eyes (splash or absorbed)
- Inhalation
- Ingestion
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How much of the substance are people exposed to during the task? (Define amount in litres, mililitres, kilograms, grams etc)
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How long are workers exposed to the substance? (Select all applicable)
- Minutes
- Hours
- Days
- Weeks
- Constant
- Rare/Intermittent
Health Effects of Exposure
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Skin
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Eyes
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Inhalation
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Ingestion/Chronic exposure
Recommended Controls
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What engineering control measures are recommended by the SDS or label?
- Eliminate substance
- Substitute substance
- Isolate substance
- Ventilate area
- Admin controls
- PPE
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Describe 'Other' if applicable
Current Controls
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What engineering control measures are CURRENTLY used to control exposure to the substance?
- Extraction
- Ventilation
- Dilution Ventilation
- Other (see below)
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Describe 'Other' if applicable
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If engineering controls are used, are they maintained and checked for effectiveness?
Personal Protective Equipment
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What personal protective equipment is recommended by the SDS and/or label?
- Eye Protection
- Skin Protection
- Respiratory Protection
- Hand Protection
- Full Body Protection
- Hygiene Protection
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What personal protective equipment is currently used at the workplace?
- Eye Protection
- Skin Protection
- Respiratory Protection
- Hand Protection
- Full Body Protection
- Hygiene Protection
Other Protective Strategies
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Are any other control measures (e.g. procedures, rotation of staff, using substances after hours to reduce exposure) recommended by the SDS and/or label? Describe.
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Are any other control measures currently used in the workplace? Describe.
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What is the level of risk from use of this substance? (Select one response only). If uncertain about the risk, air monitoring and/or health surveillance should be undertaken.
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Is air monitoring required?
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What control measures are recommended? Provide details below.
- Eliminate substance
- Substitute substance
- Isolate substance
- Ventilate area
- Admin controls
- PPE
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Details
Health Surveillance
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Health surveillance is required if someone has an adverse effect from a substance, or the level of risk is significant and the substance contains (or is) one or more of the following:<br><br>• 4,4’ Methylenebis (2-chloroaniline) (MOCA) <br>• Acrylonitrile <br>• Asbestos <br>• Benzene <br>• Cadmium <br>• Creosote <br>• Crystalline silica <br>• Inorganic arsenic <br>• Inorganic chromium <br>• Isocyanates <br>• Organophosphate pesticides <br>• Pentachlorophenol (PCP) <br>• Polycyclic aromatic hydrocarbons (PAH) <br>• Thallium <br>• Vinyl chloride <br><br>Is health surveillance required?
