ACTIVITY:__________________________________________________ PI: _________________________________________________________
LOCATION: _____________
(Room No.)
ASSESSMENT UNDERTAKEN BY:_______________________________ ASSESSMENT DATE:______________________ ASSESSMENT REVIEW DATE:_____________________
Use Material
Safety Data
Sheets
LIST
CHEMICAL
NAMES
HEALTH HAZARD CATEGORIES OTHER HAZARDS EXPOSURE CONTROLS
TRAINING EMERGENCY
PROCEDURES/
EQUIPMENT

Are the following hazards identified?
Exposure to Public
Pressure Hazards
Static Electricity Hazards
If needed are controls in place for
Shielding
Grounding &
Bonding
Cold Protection
Has training been provided for
Lifting
Respiratory
Protection only if needed

I have completed this risk assessment and I am fully aware of the hazards involved in the above activity and of the essential safety precautions to be taken. I acknowledge with my signature here that I will comply with the safety precautions that this work requires.
Signature of Assessor
Researcher/Staff
Date
I have personally ascertained that the Assessor is aware of the hazards involved in the above activity and the precautions to be taken. I am satisfied that any hazards that were identified are adequately controlled and these controls will be regularly checked. This activity is deemed to be safe and has my approval.
Signature of Supervisor:
PI/ Head of Department
Date