Information

  • Chemical Name

  • Manufacturer / Supplier

  • Department

  • Prepared by

  • Conducted on

  • Location
  • Date of assessment

  • Completed by

  • People involved in assessment

Chemical Summary

  • Manufacturer / Supplier

  • Chemical name

  • Are we currently using this Chemical? If no, notify Engineering

  • Take photo of the chemical

  • Is there a current SDS on the Chemical Register (must be under 5 years old to be current)

  • Date of MSDS

  • Is the chemical classified as Hazardous or a Dangerous Goods?

  • Dangerous Code

  • Check SDS 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?

  • Date of Risk Assessment.

  • What is the risk rated in the assessment 0=Very Low to 5=Very High (use this information in your new assessment)

  • If the Chemical is a Hazardous or a Dangerous Goods, view the SDS and Chemical label and decide whether there is a risk to staff. In reviewing the risk consider the questions asked below and whether the suggested safety measures (from label and MSDS) are being followed. 0=Very Low to 5=Very High

  • 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

  • What is the chemical used for?

  • What control measures have we put in place when using this Chemical

  • What department uses the Chemical

  • Engineering

  • Housekeeping

  • Food & Beverage

  • Purchasing

  • Administration

  • Where is the Chemical stored?

  • Housekeeping

  • Engineering

  • Loading Dock

  • Kitchen

  • Where is Chemical used

  • Chemical is used - All Areas

  • Chemical is used - Rooms / Public Areas

  • Chemical is used - Night Cleaner

  • Chemical is used - Workshop

  • Chemical is used - Gardens

  • Chemical is used - Pool / Spa

  • Chemical is used - Beverage Store

  • Chemical is used - Bar

  • Chemical is used - Executive Lounge

  • Chemical is used - Main Kitchen

  • Chemical is used - Kitchens

  • Chemical is used - BBQ's / Gas Heaters

  • Chemical is used - Forklift

  • Chemical is used - Generator

  • What is the maximum quantity held on site (in litres)(if over 50 litres, use 50 and detail amount)

  • Enter amount if over 50 litres

  • What is the length of time the Chemical is used with out a break (in minutes)(if over 60 minutes, use maximum and enter amount)

  • Enter amount if over 60 mintues

  • How often over a month period is the Chemical used (in days)

Does the chemical have health hazards?

  • Has this Chemical resulted in any internal injury reports or internal hazard reports

  • Acute (Immediate) effects

  • Eye and skin irritant / Corrosion

  • Central Nervous System

  • Toxic by inhalation (breathing in)

  • Toxic by skin exposure

  • Toxic by ingestion (swallowing)

  • Other (please detail below)

  • Other

  • Chronic (Delayed) effects

  • Skin / Inhalation effects

  • Liver/Kidney effects

  • Brain/Nerve effects

  • Respiratory effects

  • Reproductive System effects

  • Carcinogenic (can cause cancer)

  • Other (please detail below)

  • Other

Does the Chemical have exposure controls or personal protection equipment requirements

  • Does the Chemical have exposure standard (ref to the SDS)(exposure standards are a limit as to the quantity of Chemical one can be exposed to)

  • Does the Chemical require health monitoring?

  • What PPE is required for the use of the Chemical

  • Safety Glasses / goggles

  • Safety foot wear

  • Face shield

  • Overalls

  • PVC Apron

  • Respirator

  • Detail the type of filter required

  • Gloves

  • Detail the type of gloves required

  • Hearing protection

  • Is the PPE required being warn? Yes - all the time / Yes - Some, all the time / Some, some of the time / No

Conclusions

  • 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.

  • After completed the above and taking into account the risk score what is your risk rating 0=Very Low to 5=Very High

  • What are the conclusions about the risk?

  • 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.

  • What are you going to do in order to reduce the risk

  • Review current control measures

  • Put in place new control measures

  • Undertake exposure limits (test the air/Chemical levels when the Chemical is being used)

  • Training required

  • Undertake risk assessment on a yearly basis

  • Eliminate / Substitute the Chemical with a acceptable risk

  • Seek external advise

  • Please sign your name

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.