CHE_HSD0633 Pre Purchasing Request-Checklist for Hazardous Materials
Reference HS316: Purchasing Guidelines
Faculty/Division:
ENGINEERING
Document number
CHE_HSD0633
School/Unit:
CHEMICAL ENGINEERING
Initial Issue date
11/02/2015
Current version
3
Current Version issue date
17/06/2015
Next review date
17/06/2018
This form should be used to assess the risks of introducing new hazardous materials into the workplace. The completed form is to
be emailed from supervisor to purchaser.
Proposed Materials/Chemicals/Gases to be purchased:
Description and quantity
Supplier
Catalogue/
part no.
Pre-purchase
Health and
Safety Checks
completed *
1
☐
2
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3
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4
☐
5
☐
6
☐
7
☐
8
☐
Storage location other
comments/indicative
price(if required)
Part 2: Checklist Pre-purchase Health and Safety requirements
PRE PURCHASE HEALTH AND SAFETY CHECKS.
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Have you investigated whether safer alternatives to this chemical are available?
Has a Safety Data Sheet been obtained and has the safety information been read and understood?
Is the chemical already listed on SciQuest? [If not, who will add?]
Is the chemical a radioactive isotope? If yes, contact the Radiation Safety Supervisor
Has risk management already been completed for the task or process in which this chemical will be used? If no, the risk
management form must be reviewed and revised as applicable to take account of new or modified risks.
Could this chemical become unstable during storage and thus require monitoring to ensure environmental conditions are
met (e.g. stored under water, stored under hydrocarbon, stored at certain temperature, stabilizers added etc)? If yes, is a
system in place to monitor such conditions and dispose of the chemical by its expiry date?
Does this chemical require storage in a separate segregated storage area and if yes, is one available?
Is a safe method available to transport the chemical from the store (or goods received area) e.g. carrying basket, bunded
trolley, gas trolley, goods lift etc.
Is the substance a Prohibited or Restricted carcinogen? Check Schedule 10 of the WHS Regulation. If yes approval must
be obtained from WorkCover.
Are any engineering controls needed and if so are they in place (e.g. fume cupboard, biosafety cabinet, cytotoxic hood,
toxic substance weighing chamber)?
Is Health Surveillance required for this chemical? Refer to HS091 Air Monitoring and Health Surveillance guideline.
Is the chemical a Schedule 4 or Schedule 8 Drug? Some S4s and all S8s require additional requirements. Refer to HS331
S4 and S8 Drugs procedure.
Is the chemical listed a Precursor chemical of security concern? If yes, extra vigilance in terms of the use and storage of
the chemical is required. Refer to the Australian Government Chemicals of Security Concern website.
Is an End User Declaration required e.g. drug precursors, chemicals of security concern?
Is an AQIS permit required? See Biosafety webpage.
If this is a genetically modified organism (GMO) has approval been obtained from the UNSW IBC?
Has the necessary PPE being obtained for use of the substance, workers trained in its use and a safe storage facility
provided for such PPE?
Name of Requestor
Date
Supervisor
Date
*By submitting this purchase request, I acknowledge that I have read and completed the relevant Pre Purchase Health and
Safety Checks
Office use only
Purchaser
Sciquest requisition no./Purchase order no.
Purchase date
document1
Work Health and Safety Regulation 2011
Current version for 24 June 2014 to date (accessed 26 November 2014 at 14:17)
Schedule 10 Prohibited carcinogens and restricted carcinogens
(Clauses 340 and 380–384)
Note. The prohibition of the use of carcinogens listed in table 10.1, column 2 and the restriction of the use of
carcinogens listed in table 10.2, column 2 apply to the pure substance and where the substance is present in a
mixture at a concentration greater than 0.1%, unless otherwise specified.
Table 10.1 Prohibited carcinogens
Column 1
Item
Column 2
Prohibited carcinogen [CAS number]
1
2
3
4
5
6
7
8
9
2-Acetylaminofluorene [53-96-3]
Aflatoxins
4-Aminodiphenyl [92-67-1]
Benzidine [92-87-5] and its salts (including benzidine dihydrochloride [531-85-1])
bis(Chloromethyl) ether [542-88-1]
Chloromethyl methyl ether [107-30-2] (technical grade which contains bis(chloromethyl) ether)
4-Dimethylaminoazobenzene [60-11-7] (Dimethyl Yellow)
2-Naphthylamine [91-59-8] and its salts
4-Nitrodiphenyl [92-93-3]
Table 10.2 Restricted carcinogens
Column 1 Column 2
Item
Restricted carcinogen [CAS Number]
Column 3
Restricted use
1
2
Acrylonitrile [107-13-1]
Benzene [71-43-2]
3
Cyclophosphamide [50-18-0]
4
5
6
7
3,3’-Dichlorobenzidine [91-94-1] and its salts (including 3,3’Dichlorobenzidine dihydrochloride [612-83-9])
Diethyl sulfate [64-67-5]
Dimethyl sulfate [77-78-1]
Ethylene dibromide [106-93-4]
All
All uses involving benzene as a feedstock
containing more than 50% of benzene by
volume
Genuine research or analysis
When used in preparation for therapeutic
use in hospitals and oncological treatment
facilities, and in manufacturing operations
Genuine research or analysis
All
8
9
10
11
7
4,4’-Methylene bis(2-chloroaniline) [101-14-4] MOCA
3-Propiolactone [57-57-8] (Beta-propiolactone)
o-Toluidine [95-53-4] and o-Toluidine hydrochloride [636-21-5]
Vinyl chloride monomer [75-01-4]
Ethylene dibromide [106-93-4]
8
9
10
11
4,4’-Methylene bis(2-chloroaniline) [101-14-4] MOCA
3-Propiolactone [57-57-8] (Beta-propiolactone)
o-Toluidine [95-53-4] and o-Toluidine hydrochloride [636-21-5]
Vinyl chloride monomer [75-01-4]
document1
All
All
When used as a fumigant
Genuine research or analysis
All
All
All
All
When used as a fumigant
Genuine research or analysis
All
All
All
All