Local Risk Assessment Worksheet for Work with Biological
Materials
Completed By: Enter text here.
Date Completed: Enter text here.
Material Description
1. Name or Description of material being handled:
Enter text here.
2. Is material considered pathogenic: ☐ Yes ☐ No
If Yes…
If No…
Indicate why it is considered non-pathogenic:
Indicate Risk Group: ☐ 1 ☐ 2 ☐ 3
 ☐ Material comes from an otherwise
How was risk group determined?
healthy individual; or,
 ☐ Pathogen data sheet

☐ Material comes from the environment in
 ☐ By supplier or other researcher
an unaltered state: or
 ☐ Pathogen risk assessment

☐ Other: Enter text here.
 ☐ Other:
Personnel Factors
1.
Vaccine available?

☐Yes - Name of vaccine:
☐No
☐N/A
All personnel working with or near any of the above material in use have been:
Offered any available vaccinations and the department has a record of the
vaccination being received OR declined with counselling.
Is a medical surveillance plan in place and documented. Please Describe:
☐ Yes ☐ No
☐ Yes ☐ No
Enter text here.
Is a Medical Contact Card required?
☐ Yes ☐ No
Instructed in signs and symptoms of infection
☐ Yes ☐ No
2. PPE required when working with agent (check all that apply)
☐Face shield
☐safety glasses
☐N-95
☐ face mask
☐back-closing gown at BSC
*Note: lab coat, close toed shoes, and gloves are all mandatory for all microbiological work!
3. Frequency of contact with agent: ☐Routine/daily ☐Weekly ☐Random/monthly /yearly
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Assessment of Factors Associated with the Specific Work Processes
4. Concentrations and volumes used:
Largest single volume used:
☐< 1Litres
☐1-10Litres
☐>10Litres
Indicate volume if greater than 10 L
Indicate concentrations used (If concentrated
enter both before and after concentrations):
Enter text here
Indicate concentration required to cause
infection: ☐ N/A
Enter text here
5. Is all work with the active agent done in a BSC? ( not required for CL1 ) ☐Yes
☐No
☐Yes
☐No
6. Is bench work completed on agent?
Is material inactivated prior
to manipulation?
☐ Yes ☐ No
If NO, indicate type of procedures done on open bench (refer to
SOPs used): Enter text here
How will the hazards of
exposure by bench work be
mitigated?
Enter text here
Will any process performed
on the bench create
aerosols?
☐ Yes ☐ No
If YES, indicate how exposure to aerosols will be minimized: Enter
text here
7. Will sharps be used?
If YES, are you using safety engineered sharps? If not, explain: Enter text here
☐Yes ☐No
8. Processes that increase exposure potential should be identified. Do you use any of the
following processes (check all that apply):
☐ Cell sorting
☐ Sonication
☐ Centrifuging in open containers
☐ Blending
☐ Flaming loops
☐ Shaking or vigorous mixing
☐ Grinding
☐ Pipetting
☐ homogenizing
☐ Opening containers with high internal pressures
☐Other procedures that may create an airborne exposure to a pathogen: Enter text
here
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9. Will your experiments involve centrifugation?
☐ Yes ☐ No
a. If YES, are sealed rotors, or sealed centrifuge safety cups available for use?
☐ Yes ☐ No
b. If NO to “10 a”, do you only use screw –cap non-glass tubes? ☐ Yes ☐ No
c. Will you open the tubes in the BSC after centrifuging?
☐ Yes ☐ No
If YES, click here to explain how you will protect against exposure.
Disinfection and Waste Disposal
10. At what stage of your work will the infectious agent be inactivated or lysed? ☐ N/A
Enter text here – note N/A should only be used if there is no infectious agent.
11. Specify disinfectants and decontaminants and decontamination procedures in use: ☐
N/A
Disinfectant
Contact Time
(min)
Enter text here.
Preparation
Frequency
Enter text here.
Used Against
Enter text here.
Working
Concentration
Enter text here.
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12. Complete the table to identify how biohazardous wastes generated by your research are
treated (Any autoclaving and direct disposal requires weekly efficacy logs):
Waste Generated and disinfection process
Disinfection
Parameters
Solid waste contaminated with biohazardous material and all
☐Yes
☐ N/A
microbial and eukaryotic cell cultures, including broth cultures.
Autoclave temp & time
☐No
Disposal
by:
Enter text here oC
☐N/A
☐Biowaste bin (UW Disposal Service) or ☐Autoclaving
Enter text here min.
☐Yes
☐No
☐N/A
(Sharps) Needle and syringe assemblies will be
☐ N/A
Disposed by:
☐Biowaste sharps bin (UW Disposal Service) or ☐Autoclaving
Autoclave temp & time
Enter text here oC
Enter text here min.
☐Yes
☐No
☐N/A
Used glass and hard plastic pipettes and Pasteur pipettes will be:
Disposed by:
☐Biowaste sharps bin (UW Disposal Service) or ☐Autoclaved and
disposed as regular waste
☐ N/A
☐Yes
☐No
☐N/A
Liquid waste contaminated with biohazardous material will be
Disposal by:
☐Biowaste bin (UW Disposal Service) , ☐Autoclaving,
☐ Chemically
Enter Autoclave temp
and time OR chemical
contact time here.
☐Yes
☐No
☐N/A
Other, specify: Enter text here
Enter text here
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Name of Solution
Enter text here
Contact time
Enter text here hrs
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Summary:
Summarize the SOPs or describe the processes you will be using to minimize risk. Use reference
numbers or naming conventions that you use in your lab, and provide a short description of its
purpose. These must be made available to the Biosafety Officer upon request.
Identify SOPs or Controls used for your work
Example – SOP 734 – Purification of xxx by centrifugation….
Enter text here
Enter text here
Enter text here
Identify Controls used for your work
Enter text here
Safety Office Comments:
Supervisor Name:
Signature:
Date:
Biosafety Officer Name:
Signature:
September 2015
Date:
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