Department of Chemical and Process Engineering
Hazard & Risk Checklist
Please see the Hazard and Risk Checklist Overview in the Safety Manual for additional information.
Expt. Name
Researcher
Full Name:
Cell Phone #
E-mail:
CAPE Supervisor
I have read and understood the relevant sections of the Safety Manual.
Date:
Student Signature:
I have reviewed this document for correctness and validated any
process flow diagrams.
Date:
Supervisor Signature:
Location Of Experiment
Rm #
Safety Quiz completed
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Details entered on the Room Map on the door
This experiment is considered a “Significant Hazard”
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Chemical Handling Approval:
Date:
Electrical Approval:
Date:
Mechanical Approval:
Date:
Safety Officer Approval:
Date:
Expiry date of the Orange Card:
Annual Review Modifications: Active Safety Devices – Annual Check:
Notes:
2014
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Approval and Date
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1. Equipment & Materials
1.1 Equipment: Please list all the equipment that will be used including common items such as balances, ovens and chromatographs. Also include
equipment that has been assembled as part of a custom setup including computers. Add as many rows as necessary.
Item
#
Equip.
tag #
Equipment item name
Electrical
expiry date
Location
(Rm #)
Training
done by
List normal operating
extremes (T, P, pH)
Running
unattended
Additional PPE
required
Active Risk
Reduction Devices
1.2 Diagram: Attach a process flow diagram of the apparatus or line diagram of the experimental setup must be attached. It must be your own work; a
direct copy of a previous diagram is not permitted.
1.3 Pressure test design/certificate required? Y / N
1.4 Chemicals: List each chemical that will be used and complete the table. See Overview document for definitions.
Hazard rating
Chemical
Fire
Toxic
Body
React
Chronic
Tracked
class
Max
conc.
Working
conc.
Total lab
vol.
Safety precautions, special disposal, comments
Print out a mini MSDS (Material Safety Data Sheet) for each of these materials and attach to the hard copy of this form. You will eventually place them in
the folder outside your lab
1.5 Biological: List each biological sample, viruses or microorganism that will be used.
Biological Material / Organism
2014
Quantity &
conc.
PC 2
(Y/N)
Pathogen
(Y/N)
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Source / Special considerations / Notes
2. Procedures / Emergency Response
2.1 Procedures: Write an experimental procedure, and include it in this document as an appendix.
2.2 Animals/native plants: Are there any ethical or ethnic considerations or requirements, e.g., working
with live animals, processing native plants? Y / N
2.3
Emergency Safety Equipment:
Determine the location of emergency exit/s, fire alarms and extinguishers.
Determine the location of the nearest drench showers and eye wash station.
Determine the location of the nearest chemical spill kit (if applicable).
Confirm overflow protection in place and hoses clamped (if applicable).
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2.4 After-hours work
Is work permitted after-hours or in an isolated area during the day?
Y/N
If ‘yes’ to either of the above, select one of the following options for contact with others.
a) Someone will contact University Security if you do not come home or make contact.
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b) Ordinary or phone audible contact with a buddy every 15 minutes – interactive
experimentation with some risk.
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c) Full-time audible and visual contact – potential for rapid or serious incident.
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2.5 Unexpected Events: Consider and list any safety consequences of unexpected events.
Event
Consequences
2.6 Safety Incidents: List the history of Safety Incidents (if any) with this equipment and/or experiment.
Item name
2014
Notes
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