Note: *If the substance has a R45 or R49 risk phrase or a H350 or H350i hazard statement, it must also be registered on your personal carcinogen return (at Occupational Health) where exposure is not adequately controlled.
Name of Chemical
What will the chemical be used for?
Who may be exposed?
Hazardous Properties (Provide details of how the substance could cause harm, e.g. harmful by inhalation, skin contact, flammable, carcinogen, allergen, etc)
Quantity (Indicate how much of the substance will be used)
Workplace Exposure Limits (WELs)
- Eye contact
- Skin contact
- Spill procedure
What are the emergency procedures needed?
- Total containment
- Fume cupboard
- Local exhaust ventilation
- Blast screen
other engineering control needed
- Restricted to competent personnel
- Special containment facility
other access control needed
- Code of Practice, local rules, etc
other special procedure needed
- Eye protection
- Laboratory coat
- Other PPE
Other approved PPE used
Disposal Procedures Note: (Give details of waste disposal procedure to be used)
Are chemicals with risk phrases R50-R59 or hazard statements H400 – H413 (environmental hazards) involved?
Training Requirements Note: (List any specialised training requirements before work can begin)
Handling and Storage Requirements (Note any special requirements e.g. ventilation, chemical incompatibility, flash point, etc)
Are the hazards/risks suitably controlled, using the control measures detailed above?
state the further actions required, e.g. Requirement for a standard operating procedure (SOP), etc
I confirm that I have considered and understand the chemical to be used and the associated hazards. I am satisfied that all of the hazards have been identified and that the control measures to be followed will reduce the risks to as low a level as reasonably practicable.