Risk Assessment Report

TASK NAME

PRODUCT(S)

Task/Usage Details
Task Description
Frequency
Duration

Assessment Details
Assessment Team
Operator(s)
Location of Use
Assessment Date
Next Review Date

Control Details
Elimination
Can the chemical be eliminated in its entirety? Yes | No | Not Applicable | Not Assessed
Does this process/task need to be undertaken? Yes | No | Not Applicable | Not Assessed
Has elimination been adequately considered for this task? Yes | No | Not Assessed
Comments

Substitution
Are there any less hazardous chemicals appropriate for the task? Yes | No | Not Applicable | Not Assessed
Is the chemical in its least hazardous practical form (e.g. pellet instead of Yes | No | Not Applicable | Not Assessed
a powder)?
Has substitution been adequately considered for this task? Yes | No | Not Assessed
Comments

Isolation
Is this chemical isolated from workers during the task?
Is the chemical stored remote from workers?
Are the isolation control measures in place adequate for the task?
Comments
Yes | No | Not Applicable | Not Assessed
Yes | No | Not Applicable | Not Assessed
Yes | No | Not Assessed

Engineering
Is suitable (natural or mechanical) ventilation in use during this task? Yes | No | Not Applicable | Not Assessed
Are automated systems available to prevent manual handling of the Yes | No | Not Applicable | Not Assessed
chemical?
Are the engineering control measures in place adequate for this task? Yes | No | Not Assessed
Comments

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TASK NAME

Administrative
Is training provided for all people at risk during this task?
Are safe work procedures available for this task?
Are the administrative control measures in place adequate for this task?
Comments
Yes | No | Not Applicable | Not Assessed
Yes | No | Not Applicable | Not Assessed
Yes | No | Not Assessed

PPE
Is suitable PPE available to anyone at risk of exposure? Yes | No | Not Applicable | Not Assessed
Are all PPE items maintained and in good working order? Yes | No | Not Applicable | Not Assessed
Are the PPE control measures in place adequate for this task? Yes | No | Not Assessed
Is PPE mandatory for this task? Yes | No
Eye/Face
Hand
Body
Respiratory
Comments

Risk Analysis
Risk Matrix Ranking

Conclusions Risk is negligible | Risk is present, but effectively controlled | Risk is present, but not adequately controlled
| Uncertain
Recommendations /
Actions Required

Approval
Approved By

Signature
Position
Date Approved
Comments

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TASK NAME

Product Assessment:

Manufacturer/Supplier
Product Form SDS Date
Flammability Flash Point
Lower Explosion Limit Upper Explosion Limit
pH Solubility
Quantity Concentration

Hazard Details
Hazard Classification
Risk phrases

Safety phrases

DG Classification

Land Sea Air

Shipping Name
UN Nº
DG class/division
Subsidiary Risk
Packing Group
Hazchem Code

Storage Details
Package Size
Container Type
Quantity Stored
(maximum)
Stock Location
Are there any transportation/storage risks associated with this product? Yes | No | Not Assessed
Details

Are there any fire/explosion risks associated with this product? Yes | No | Not Assessed
Details

Are there any stability/interaction risks associated with this product? Yes | No | Not Assessed
Details

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TASK NAME

Environmental Details
Are there any environmental impact risks associated with this product? Yes | No | Not Assessed
Details

Are there appropriate spillage containment facilities available (eg. bunding)? Yes | No | Not Assessed
Details

Are there appropriate waste disposal facilities available? Yes | No | Not Assessed
Details

Exposure Details
Routes of Exposure Eye Contact • Inhalation • Skin Contact • Ingestion • Injection
Are Monitoring Details attached? Yes | No
Are any of the Exposure Standard(s) likely to be exceeded (if applicable)? Yes | No | Not Assessed

TWA STEL
Substance Reference
ppm mg/m³ ppm mg/m³

Health Effects
Potential Health Effects
Acute Irritant • Corrosive • Toxic • Sensitisation • Central Nervous System • Asphyxiant
Chronic Carcinogenic • Liver Damage • Kidney Damage • Nervous System Damage • Respiratory Damage •
Reproductive Damage
Reported Health Effects
Have any incidents or diseases been reported with the use of this chemical in your Yes | No | Not Assessed
workplace?
Details

Classification Acute (Immediate Effects) | Chronic (Delayed Effects)

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