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Research Risk Assessment
IRM_FM_009
March 2014
Research Risk Assessment Form
The risk assessment form is designed to lead the principal investigator, faculty advisor or project supervisor with the
objective of predetermining the necessary control measures prior to the start of work or purchase of equipment.
The principal investigator, faculty advisor or project supervisor should complete the form, and have the department
head of the department review the form. There may be resource requirements associated with your research/project
that would require some commitment from either you and/or your department.
Integrated Risk Management (IRM) is available throughout the risk assessment process. Contact the Environmental
Health and Safety Officer at ext 7086 if you have any questions or email at irm@ryerson.ca
Process for Research Risk Assessment Form
1. Reviewed and filled out by the principal investigator/faculty advisor/project supervisor and then signed off
2. Reviewed and either sent back to the Supervisor for revisions/additions and/or signed off by the department
head as complete.
3. The original of the COMPLETED Research Risk Assessment Form must be sent to Integrated Risk Management
(IRM)
4. A copy kept within the department
If you feel that the Research Risk Assessment Form hasn't adequately addressed your research / project, please
provide any additional information that would help to expedite the Assessment.
A. Contact Information
PLEASE TYPE OR PRINT CLEARLY
Name:
Dept:
Position:
Principal Investigator
Project Supervisor
Email:
Faculty Advisor
Phone Extension:
Mailing Address:
Integrated Risk Management, JOR-1119
T: 416-979-5000 x 7086
Email: irm@ryerson.ca
Web: www.ryerson.ca/irm
Other
List of people working on project and their affiliation (faculty, staff, undergraduate or graduate student, full time or part-time, contract or external
to Ryerson). Provide attachment if space is insufficient.
Name
Affiliation
B. Project Type
Research
Student Thesis
New Curriculum Planning
New Equipment
Renovation/Construction
Process Change
International Travel
Special Event
Other (specify)
Estimated Start Date:
Project Location (Bldg & Rm No.
Project Description:
Funded:
No
Yes
ORS Application #: ___________________________________
ORS Officer #:
________________________________________
Faculty of Primary Appointment:
____________________________________
C. Hazards Inventory & Risk Level
Please review all categories and check ALL applicable equipment/agents or activities and estimated risk level for each category. See
Explanatory Notes for Supplementary Information on Risk Analysis Tables. For projects with several hazardous agents, they may be
listed below with individual risk level assessments.
The Supplementary information can be found here: http://www.ryerson.ca/irm/riskmgmt/oncampus.html
EXAMPLE:
Likelihood of an event (Table 1) = should occur at some time LIKELY
Consequence (Table 2) = First aid treatment, on-site release immediately contained, medium financial loss MINOR
Risk (Table 3) = Significant
Agents
IDENTIFY the RISK LEVEL as High / Significant / Moderate / Low
H
S
M
L
H
S
M
L
H
S
M
L
Biological Agent (e.g., cell cultures, virus, bacteria)
Chemical including all WHMIS classes, cryogenics, etc.
Emission (e.g. dust, odour, heat, particulates, hazardous waste, etc.)
Excessive noise (> 85 dBA)
Excessive vibration
Radioactive Agent (including sealed sources in equipment)
Temperature extremes (< 4oC or > 35 oC)
Other (please list):
Equipment Inventory
IDENTIFY the RISK LEVEL as High / Significant / Moderate / Low
Autoclave
Centrifuge
Cutting, puncture or crushing devices
Equipment with exposed moving parts
Excessive weight/floor loading (>80 pounds per ft2)
Laser (Provide Class Number: ________________________________________)
Lifting Device (e.g. crane)
Pressure vessels (e.g. gas cylinders, vacuum, boilers)
Rigging Device
Sharps
X-ray equipment
Other (please describe):
Activities
Confined or restricted space
Elevated height (> 3 metres off ground)
Working Alone or in Isolation
Off campus activities
Travelling outside Canada
Other (please describe):
IDENTIFY the RISK LEVEL as High / Significant / Moderate / Low
HAZARDOUS MATERIALS INVENTORY (i.e., specific chemical, radioactive and/or biohazardous agent(s)].
Please specify concentrations, estimated amounts, activity (for radioactive materials). Provide attachment if space is insufficient.
Agent
Amount
Concentration
MSDS Available
YES
NO
Can the hazardous material be eliminated or substituted to a material less hazardous?
No
Yes
List Substitute:
D. Hazard Control Program
Identify hazard control programs and procedures that would be applicable and additional requirements for specific project
(refer to Appendix B). Provide attachment if space is insufficient. Item with asterisk * indicates a separate application for an internal
permit/certificate is required.
D 1. Agents
Program
*Biological Agent (e.g., cell cultures, virus, bacteria)
Application for Biosafety Certificate
Chemical including all WHMIS classes, cryogenics, etc.
WHMIS Program
Emission (e.g. dust, odour, heat, particulates, hazardous waste, etc.)
Ventilation & Certificate of Approval (Air)
Excessive noise (> 85 dBA)
Certificate of Approval (Noise)
Excessive vibration
*Radioactive Agent (including sealed sources in equipment)
Temperature extremes (<
4oC
or > 35
Radiation Safety Program
oC)
D 2. Equipment Inventory
Program
Autoclave
Centrifuge
Cutting, puncture or crushing devices
Equipment with exposed moving parts
Machine Safety Guideline
Excessive weight/floor loading (>80 pounds per ft2)
*Laser
Laser Safety Program
Lifting Device (e.g. crane)
Pressure vessels (e.g. gas cylinders, vacuum, boilers)
Compressed Gas Cylinder Guideline
Rigging Device
Sharps
X-ray equipment
X-Ray Safety Program
D 2 B Equipment Information
YES
NO
NA
Machine guard for equipment (to prevent contact and entanglements)
Machine appropriate for area of use (explosion-proof, etc.)
Noise contributions been considered for work area
Vibration contributions been considered for work area
Have ventilation requirements for equipment been considered
Preventative maintenance arrangements for equipment
Sufficient space for safety clearances around equipment
Regular testing requirements (e.g., annual certification) in place
Does electrical equipment meet CSA/Hydro standards?
D.3 Activities
Program
Confined or restricted space
Elevated height (> 3 metres off ground)
Working Alone or in Isolation
Off campus activities
Travelling outside Canada
Travel Risk Assessment Form
D.4 Standard Operating Procedures (SOPs)
Developed for project
Yes
No
Have project participants reviewed the SOPs?
Yes
No
If no, date completed by:
D.5 Control Specifics
Describe control specifics to reduce and minimize risk level of specific hazard. Provide attachment if space is insufficient.
D. 6 Personal Protective Equipment (PPE) required for the project
Eye/Face Protection
Head Protection
Foot Protection
Hearing Protection
Hand/Skin Protection
Respiratory Protection
Fall Protection
Temperature (head or cold)
Other (specify): 

D.7 Ventilation Requirements for Hazards and/or Equipment
Describe local exhaust or general ventilation requirements including type of equipment and location. (required to minimize exposure to airborne
materials including, odour control, heat, dust, chemical, biohazards, radioactive and waste products)
Integrated Risk Management, JOR-1119
T: 416-979-5000 x 7086
Email: irm@ryerson.ca
Web: www.ryerson.ca/irm
D.8 List Permits / Special Licensing or Registration requirements used for this project
Air Emissions (C of A -- Air)
Biosafety
Biosafety Cabinets
Crane lifting capacity (annual certification)
Fork Lift
Hydro Inspection
Radioactive Material
Laser
X-ray Equipment
Hazardous Waste Removal (describe):
Other:
Have application for permits been submitted?
Yes
No
State estimated date of application:
D.9 Storage & Disposal of Hazardous Materials
Agent/Equipment temperature sensitive?
No
Yes
State Temperature Requirements:
State storage requirements for hazardous material:
State storage requirements for waste materials:
State disposal procedures for hazardous materials:
D.10 Medical Surveillance required for the project

Biological Agents (immunization)

Eye examination (laser program)

Designated Substances monitoring

Travel immunization
Other:
D.11 Hazard Communication
Do all of the chemicals being used for this project have up to date (< 3 years old) Material Safety Data Sheets sheets available?
Yes
No
Where will the MSDS’s be located?
Have all project participants reviewed the MSDS’s?
Yes
No
If no, state date completed by:
Name
Training Requirement
Date Completed By
D.13 Emergency Protocols and Equipment
Emergency procedures (spill, fire, injury etc) posted at work location?
Yes
No
Procedures reviewed with all staff/students?
Yes
No
If no, date completed by:
NA
List available emergency equipment
Eyewash
First Aid Kit
Spill Control
Shower
Fire Extinguisher
Other:
D.14 Access Considerations into Work Area
General Entry/Exit (NO SPECIAL PRECAUTIONS)
Yes
No
N/A
SPECIAL ENTRY PRECAUTIONS into work area
Yes
No
N/A
IF YES, STATE WHY precautions are required:
IF YES, are warning visual indicators (eg. signs, alarms, lights, etc.) posted prior to entering the work area?
Is ACCESS AUTHORIZED for the following personnel:
Security &
Emergency Services
Campus Facilities &
Sustainability
Caretaking
Yes
No
NA
Restrictions
Yes
No
NA
Restrictions
Yes
No
NA
Restrictions
Trades
Yes
No
NA
Restrictions
IRM
Yes
No
NA
Restrictions
Dept Safety Officer
Yes
No
NA
Restrictions
Other
Yes
No
NA
Restrictions
Other
Yes
No
NA
Restrictions
Notification of affected departments
Security &
Emergency Services
IRM
Campus Planning
Campus Facilities &
Sustainability
Caretaking
Other
Required
Not Required
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
E. Supplementary Project Information
E.1 Utilities required for the project
Natural Gas
Propane
Compressed Air
Vacuum
Natural gas
Water
Steam
Hydro/Electrical
Other:
Are the utilities present in proposed location sufficient for project?
Yes
No
If no, state additional requirements:
E.2 Equipment Serviced by these Utilities
Autoclave
Freezer
Laser
Biological Safety Cabinet
Centrifuge
Vacuum
X-ray equipment
Incubator
Fridge
Other:
Fume hood
Other:
E.3 Services of departments required for completion of project (check all that apply)
ORS
Security
Campus Facilities & Sustainability
DEHSS
CCS
Receiving
Other:
Other:
E.4 Affect of project on other Ryerson departments
Department Affected
Students
Other:
Description of Impact
Faculty
Staff
F. Principal Investigator /Project Supervisor Confirmation
I am aware of all the potential hazards and have taken all reasonable precautions
necessary to control the hazards related to this proposed activity. I have orientated my
staff on these hazards and necessary control measures, and ensured their competency to
work in a healthy and safe manner. I have obtained or in the process of obtaining the
necessary licences, and permits and have been given the necessary training. I am
familiar with the contents of applicable University health and safety policies and
programs.
Signature:
Date:
Department:
G. Dean/Director/Chair Confirmation
I am satisfied the Principal Investigator/Project Supervisor is aware of, and is
competent to manage all procedures, hazards and safety measures associated with the
project.
Signature:
Date:
RETURN Fully Completed Form to:
Department of Integrated Risk Management (IRM)
Jorgensen Hall 11th floor - 350 Victoria Street
FOR IRM USE ONLY
DISTRIBUTION
IRM
ORS (FUNDED RESEARCH)
CAMPUS PLANNING & FACITLTIES
Date Received:
Reviewed By EHS Officer
Comments:
Date:
Reviewed By Rad/Bio/Chem Safety Officer
Comments:
Date:
Integrated Risk Management, JOR-1119
T: 416-979-5000 x 7086
Email: irm@ryerson.ca
Web: www.ryerson.ca/irm