HSPS04 – HAZARDOUS SUBSTANCES RISK
ASSESSMENT FORM EXAMPLES
Health, Safety and Wellbeing Team
SECTION 1. Identify Hazardous Substances and hazards related to them
Number
Substance
1
Binder Part A Epoxy resin
2
Binder Part B Epoxy resin
3
Bauxite
4
Propane – heating fuel
Version 4 November 2011
Hazard(s) very toxic, toxic, harmful, corrosive, irritant,
flammable, explosive etc.
Irritant/harmful –danger of serious damage to health
by prolonged contact with skin, very toxic to aquatic
organisms + may cause long term adverse effects to
aquatic environment.
Toxic/corrosive –may cause harm to unborn child,
may cause long term adverse effects to aquatic
environment.
N/a
Extremely flammable, heavier than air, gas/air
mixtures are explosive, asphyxiant at high
concentrations.
Form
(solid,
liquid, gas
etc.)
WEL
From safety data
sheet
8 hr
limit
15 min
limit
Flash
point +
explosive
limits
R phrases
Liquid
100-105ºC
36/37, 43,45,
48/21,
50,53
Liquid
91ºC
21/22, 24/25,34,
36/37, 39, 43,
45,48/21,53,61
-105ºC
2-9.5%
12
Granules
(dusty)
LPG
10
mg/m³
Not protectively marked
SECTION 2: Who might be exposed, how often, and how much? – identify any secondary hazards from mixing substances.
Substance
No.
1,2,3,4
4
Staff group/other + how many
Frequency + length of exposure
exposed
6 Highways operatives
Daily for 2 operatives, occasional for
others.
Refuse staff near store at Prince
Daily
Rock depot
Level of exposure
High, med, low
Up to 44 Kg epoxy resin,
+ up to 1000 Kg Propane.
Up to 4xfull 47 Kg cylinders
+ 4 x empty
Secondary hazard from
mixtures?
None
None
SECTION 3. How might exposure occur? - routes of entry and injuries or health effects that could result.
Route of exposure
✔ if yes
Substance
No.
Inhalation
✓
1,2,3,4,
Ingestion
Absorption
Injection
Skin
✓
2
✓
1,2
Eyes
Other
✓
1,2
Health Surveillance/
Monitoring arrangements
Consequence of exposure
1,2-Irritant/harmful. 3 – nuisance.4 – Headache, vomiting,
disorientation.
Toxic/corrosive
1,2 – sensitisation. 1,4 – irritant. 2 – toxic, corrosive, may cause
cancer.
1,2- irritant. 3 – nuisance.
None
None
HSE guidance on dermatitis for operatives. Visual checks
by supervisor/OH.
N/a
SECTION 4. Emergency procedures and waste disposal arrangements
Substance/No.
1,2,(3 inhalation, eyes
+ ingestion)
4 – inhalation.
1,2, 3, 4
Emergency procedures – First aid actions, spillage procedures, fire/explosion etc.
First aid –
Inhalation: remove to fresh air. Seek medical attention if symptoms persist.
Eyes: flush thoroughly with lots of water. If irritation persists, seek medical attention.
Skin: wash with plenty of soap + water.
Ingestion: don’t induce vomiting. Give water + seek medical attention.
Spillage/leak –
absorb in inert material (sand or vermiculite) + sweep into suitable containers for disposal as hazardous
waste by specialist contractor (dispose of brushes etc. as contaminated waste).
N/a
Eliminate sources of ignition + ventilate thoroughly.
Waste disposal arrangements
React 1+2 to form inert polymer,
then dispose via Chelson Meadow
transfer station as controlled waste. –
same disposal route as 1,2.4 – return
cylinders to supplier.
Dispose as hazardous waste to a
specialist contractor – do not allow
spillages to contaminate
watercourse/sewers.
1,2,3, 4
Fire –
Use CO2, foam, dry powder or water fog only. Fire fighters must wear BA.
Water fog only – clear area due to risk of explosion.
Remaining waste must be treated as
hazardous.
SECTION 5. Risk Controls - For each substance identified in Section 1, list existing control measures.
Substance
No.
1,2,3,4
1,2
3
4
Existing controls in place to reduce risk – you must check
that these controls are actually working:
eg general ventilation; LEV; fume cupboard; gloves
(specify type); eye protection (specify); RPE (specify); protective
clothing (specify); DSEAR zone; no ignition sources; minimise
amounts; training; other (specify).
Good general ventilation in storage area, work in open air.
Smoking, eating, drinking banned + hand/eye wash facilities
provided at store/on vehicle.
Training in system use to BS/EN/ISO 9002 and ADR.
First aid kit on vehicle + all work within City boundary close to
emergency services. 2 man working at all times on the
vehicle/highways.
Epoxy resins delivered in ready to use 22Kg packs (x6 in storage,
x2 in use per month).
1Propane cylinder 47 Kg on vehicle, (up to 8 in external store).
PPE = pvc gloves, face shield/goggles (chem./impact resist),
overalls (close woven cotton, non -porous).
PPE as for 1,2 + nuisance dust mask FFP3 (disposable).
PPE = None – Propane is handled + refilled by delivery tanker
driver.
Name of Assessor(s)
K.Paull, J.Morgan,
P.Godsall, A.Rickard
(Repeat form for continuation sheets)
Residual Risk
Reduced Risk
Further action needed to
reduce risks
S
P
R
Use of alternative Keygrip
Thermoplastic Type 1+3 system heated to 225ºC.
4
3
12
4
3
12
1
3
3
3
1
4
SIGNED
Department
Tool box talks, staff training
refreshers and questionnaires.
Regular laundry service needed for
overalls.
Visual inspection by
operatives/supervisor/OH for skin
damage.
First-aid training.
Development + HR
Service Unit
Highways + H&S
(S) Severity of health effect : Insignificant = 1; Minor = 2; Moderate = 3; Major = 4; Fatal/catastrophic = 5
(P) Probability of exposure: Very unlikely = 1; Unlikely = 2; Possible = 3; Likely = 4; Almost certain = 5
(R) Risk Rating = SxP: Low = 1-5; Medium = 6-10; High = 11-15; Very high = 16-25
S
P
R
2
3
6
4
2
8
4
2
8
2
3
6
2
3
6
SECTION 6. Best practice and vulnerable staff– in this section you need to identify the best practice or standards you have used in your assessment and
identify any staff that may be considered to be more vulnerable.
6.1 Best Practice Standards
Are there any relevant best practice standards
or legal requirements which should be
followed for the hazards being assessed? e.g.
Council Policies, or guidance (corporate or
departmental), legislation, HSE guidance or
Approved Codes of Practice, British or
European Standards, professional or trade
guidance.
SECTION 7.Action Plan
List these:
Trustseal Ltd. BBA Certificate method statements,
Safety Data sheets + instructions for safe use.
COSHH Reg’s 2002, DSEAR 2002,
CHIP 2002, ADR and the Carriage Reg’s 2004.
PCC H&S Policy, and COSHH Assessment
Performance Standard.
HSE RR079 ‘An assessment of skin sensitisation by
the use of epoxy resin in the construction industry’
2004. See HSE web site www.hse.gov.uk
6.2 Vulnerable Staff
Are there any staff who may be
particularly vulnerable and at risk. If so, a
personal risk assessment should be
carried out.
List these:
None known, but
could include
asthmatics.
e.g. young persons (under 18); new and
expectant mothers, staff with disabilities
or health conditions that might increase
risk.
– list how the further action required, as identified in Section 5, will be undertaken.
Hazard
Action Required
Epoxy resins
A+B
Specialist laundry service weekly for overalls.
Monthly visual inspection of exposed skin for sensitisation reaction.
Hot + cold
materials
Emergency first aid training for Gangers + Lead Hands (1/2 - 1 day)
Costs / resources
required
Brief instruction/ training
for supervisor – contact
OH provider.
Target
Date
Jan 2006
Jan 2006
Action by
whom?
K.Paull to
arrange
Eg PCFE Appointed
person course £24p.p
Mar 2006
K.Paull to
arrange
Completion
Date
I confirm that this Hazardous Substances Risk Assessment is an accurate reflection of the risks and controls in place
YES / NO
The further action required, as outlined in the Action Plan above, will be achieved by the target dates
YES / NO – see below*
*Manager’s comments (if further resources are required etc.)………………………………………………..………………………………………….
……………………………………………………………………………………………………………………………………………..………
Signed by responsible manager:
NAME…….………………………………………………Signature……….………………………………….Date…..………………………………..
Review date
…………………………………………….
For guidance on completing this form, please refer to Council Health & Safety Performance Standard HSPS04 ‘Hazardous Substance
Risk Assessment’ available on the Health, Safety & Wellbeing Document Library, where further copies of this form can alsobe obtained.