HEALTH & SAFETY
CHEMICAL RISK ASSESSMENT FORM
Ra No.:
Date:
Version No.:
Review Date:
Authorised by:
STEP 1 – ENTER INFORMATION ABOUT THE ACTIVITY/TASK, ITS LOCATION AND THE PEOPLE COMPLETING THE RISK ASSESSMENT
Location name:
Building No.:
Room No.:
Chemical (Manufacturer’s name and product name):
Date:
Is the chemical a hazardous substance?
Yes
Class 5.2 organic peroxides
Is the chemical a dangerous good?
Yes
If “yes” list the dangerous goods class:
No
Assessed by:
No
Yes
If “yes” list the hazard statement:
H242, H319, H334 (example for benzoyl peroxide)
Is the chemical a scheduled poison?
5.2
HSR/Employee representative:
If “yes” list the poison schedule:
No
Description of work/activities/use:
Substances that are thermally unstable substances, which may undergo exothermic self-accelerating decomposition. Examples include benzoyl peroxide.
Are there any licencing/permit requirements?
Yes
If “yes” provide details:
Health surveillance requirements (list “nil” if not required):
No
Nil
A current MSDS/SDS is available
Yes
Exposure route of chemical:
Inhalation
Skin (absorption)
Eye
Ingestion
Injection
Other – Specify:
Workplace conditions (Describe layout and physical conditions - including access and egress):
A purpose built laboratory fitted with fume hoods and restricted access.
What are the storage requirements?
What are the waste/disposal requirements?
Store in a Class 5.2 storage cabinet that complies with AS 2714. The storage of Class 5.2 dangerous
goods segregated from all other dangerous goods classes. Organic peroxides have particular
temperature requirements and must be stored at the temperature stipulated n the MSDS/SDS.
Use the University waste procedure and the preferred hazardous waste contractor
List systems of work for the activity/task:
Chemical management training
● Training
● Inspections
Chemical handling SOPs
● SOPs
● Existing controls
Scheduled bi-monthly lab inspections
● Emergency situations
Is there past experience with the chemical that may assist in the assessment?
Chemical management training
● Existing controls
● SOPs
● Standards
Chemical handling SOPs
● Industry standards
● Incidents & near-hits
● Legislation & Codes
AS 2714 The storage and handling of organic peroxides
● Training
● Incident Investigation
● Guidance material
Dangerous Goods (Storage and Handling) Regulations 2012
AS 2243.1-10 Safety in laboratories
OHS Act 2004
OHS Regulations 2007
University of Melbourne chemical management guidance material. Chemical Risk Management Procedure
safety.unimelb.edu.au
HEALTH & SAFETY: CHEMICAL RISK ASSESSMENT FORM – CLASS 5.2 ORGANIC PEROXIDES 1
Template date: June 2015 Version: 1.0 Authorised by: Associate Director, Health & Safety Next Review: June 2018
© The University of Melbourne – Uncontrolled when printed.
First aid and emergency requirements
University of Melbourne and local area emergency procedures (see last page).
● Additional first aid kit contents
● Special first aid requirements (eg oxygen)
Local area first aid procedures (see last page).
● Emergency eyewash
● Emergency shower
Vermiculite or attapulgite spill kit
● Spill kit
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● Neutralising agent
● Restrict access
Eye and burn modules
HEALTH & SAFETY: CHEMICAL RISK ASSESSMENT FORM – CLASS 5.2 ORGANIC PEROXIDES 2
Template date: June 2015 Version: 1.0 Authorised by: Associate Director, Health & Safety Next Review: June 2018
© The University of Melbourne – Uncontrolled when printed.
STEP 2: SELECT A RISK RATING METHOD
TWO VARIABLE RISK MATRIX
THREE VARIABLE RISK CALCULATOR
(1) Definitions of likelihood labels
(1) Definitions of exposure variables
Likelihood (Probability)
Exposure
E
Level
Descriptor
Description
Expected to occur
Continuously or many times daily
10
A
Almost certain
The event will occur on an annual basis
Once a year or more
Frequently: Approximately once daily
6
Occasionally: Once a week to once a month
3
Infrequently: Once a month to once a year
2
B
Likely
The event has occurred several times or
more in your career
Once every three years
C
Possible
The event might occur once in your career
Once every 10 years
Rarely: Has been known to occur
1
D
Unlikely
The event does occur somewhere from time Once every 30 years
to time
Very rarely: Not known to have occurred
0.5
E
Rare
Heard of something like the event occurring
elsewhere
(2) Definitions of likelihood variables
Once every 100 years
(2) Definitions of consequence labels
Severity level
Consequences
V Catastrophe
One or more fatalities and/or severe irreversible disability to one or more
people
IV Major
Extensive injury or impairment to one or more persons
III Moderate
Short term disability to one or more persons
II Insignificant
Medical treatment and/or lost injury time <2 weeks
I Negligible
First aid treatment or no treatment required
Likelihood
L
Almost certain: The most likely outcome if the event occurs
10
Likely: Not unusual, perhaps 50-50 chance
6
Unusual but possible: (e.g. 1 in 10)
3
Remotely possible: A possible coincidence (e.g. 1 in 100)
1
Conceivable: Has never happened in years of exposure, but possible (eg 1 in 1,000) 0.5
Practically impossible: Not to knowledge ever happened anywhere (e.g. 1 in
10,000)
0. 1
(3) Definitions of consequence variables
(3) Risk rating matrix
Likelihood
Consequence label
label
I
II
III
IV
V
A
Medium
High
High
Very high
Very high
B
Medium
Medium
High
High
Very high
C
Low
Medium
High
High
High
D
Low
Low
Medium
Medium
High
E
Low
Low
Medium
Medium
High
Consequences
C
Catastrophe: Multiple fatalities
100
Disaster: Fatality
50
Very serious: Permanent disability/ill health
25
Serious: Non-permanent injury or ill health
15
Important: Medical attention needed
5
Noticeable: Minor cuts and bruises or sickness
1
(4) Risk score calculator
Risk Score = E x L x C
Risk score
Risk rating
> 600
Very high
300 - 599
High
90 - 299
Medium
< 90
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Low
HEALTH & SAFETY: CHEMICAL RISK ASSESSMENT FORM – CLASS 5.2 ORGANIC PEROXIDES 3
Template date: June 2015 Version: 1.0 Authorised by: Associate Director, Health & Safety Next Review: June 2018
© The University of Melbourne – Uncontrolled when printed.
STEP 3 – REVIEW CHEMICAL PROCESS
For each stage of the chemical risk assessment:
Hierarchy of Control (Control Type)

Review the prompts/examples for each route of exposure for each category;
El – Elimination

Determine and record a raw risk score by referencing the two variable risk matrix or the three variable risk calculator;
S – Substitution

In the comments box, describe the route of exposure and any other information (if applicable);
En – Engineering

Specify the risk control type for each current or proposed risk control;
Sh – Shielding

Provide a control description for each current or proposed risk control;
A – Administrative T – Training

Where proposed risk control(s) have been identified complete a Health & Safety Action Plan;
M – Monitoring

Determine the residual risk score referencing the same two variable risk matrix or three variable risk calculator used to determine the raw
risk score.
P – PPE
Category
Raw
Risk Score
Storage
Comments (when/where the exposure is present)
Control Type
1 x 3 x 50
Inhaltion associated with poor ventilation
En
● Inhalation
● Skin (absorption
= 150
Corrosive to skin and eyes
Is
● Eye
● Ingestion
Medium
Fire
In
● Injection
● Other
A
Handling
2 x 3 x 50
Inhaltion
En
● Inhalation
● Skin (absorption
= 300
Corrosive to skin and eyes
A
● Eye
● Ingestion
High
Fire
T
Some organic peroxides are sentaitve movement and
friction.
P
2 x 3 x 50
Inhaltion
El
= 300
Corrosive to skin and eyes
En
High
Fire
Is
Some organic peroxides are sentaitve movement and
friction.
A
● Injection
● Other
Decanting/Mixing
● Inhalation
● Skin (absorption
● Eye
● Ingestion
● Injection
● Other
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T
P
Is – Isolation
G – Guarding
In – Inspection
H – Health Monitoring
For information devising appropriate controls, refer to: Guide to
Chemical Risk Hierarchy of Control.
Control Description
(Current and Proposed)
Limit quantities in storage to as low as reasonably
practicable.
Store in a cabinet that complies with AS 2714 segregated
from all other dangerous goods classes.
Organic peroxides have particular temperature
requirements and must be stored at the temperature
stipulated n the MSDS/SDS.
Restricted access.
Regular scheduled inspections.
Chemical management training.
Secure to suitable troleey when moving.
Limit quantities in laboratories to as low as reasonably
practicable.
Wear appropriate eye and face protection, protective
clothing and gloves as per MSDS/SDS.
Other PPE as determined by activity/use and MSDS/SDS
(see last page for details of commonly used/required
PPE).
Purchase in quantites where decanting is not required –
if still required then the following applies:
 Decant in a designated decanting area – ventilation,
earthing, no ignition sources.
 Decanting SOP.
 Manual handling training.
 Chemical management training.
 Wear appropriate eye and face protection,
protective clothing and gloves.
Residual
Risk Score
Low
Low
Medium
HEALTH & SAFETY: CHEMICAL RISK ASSESSMENT FORM – CLASS 5.2 ORGANIC PEROXIDES 4
Template date: June 2015 Version: 1.0 Authorised by: Associate Director, Health & Safety Next Review: June 2018
© The University of Melbourne – Uncontrolled when printed.
Category
Raw
Risk Score
Comments (when/where the exposure is present)
Control Type
Control Description
(Current and Proposed)
 Other PPE as determined by activity/use and
MSDS/SDS (see last page for details of commonly
used/required PPE).
 Signage.
Residual
Risk Score
2 x 3 x 50
Inhaltion
En
Use only in a fume hood.
Medium
● Skin (absorption
= 300
Corrosive to skin and eyes
A
● Eye
● Ingestion
High
Fire
T
● Injection
● Other
Some organic peroxides are sentaitve movement and
friction.
In
Reactions to be contained in a sealed reaction vessel in a
fume hood with a current test certificate and fire
damper.
Applying/Using
● Inhalation
P
Use a polycarbonate blast shield in front of apparatus.
Scale reaction down to reduce the likely damage in the
event of fire or explosion.
Chemical management training.
Read MSDS/SDS before using for the first time.
Wear appropriate eye and face protection, protective
clothing and gloves.
Other PPE as determined by activity/use and MSDS/SDS
(see last page for details of commonly used/required
PPE).
Workplace inspections.
Spill/Leak
1 x 3 x 50
Inhaltion
Is
● Skin (absorption
= 150
Corrosive to skin and eyes
A
● Eye
● Ingestion
Low
Fire
T
● Injection
● Other
Some organic peroxides are sentaitve movement and
friction.
P
● Inhalation
Have appropriate spill kit and cleanup equipment
available.
Low
Know local emergency procedures and evacuation
routes.
Other PPE as determined by emergency procedures (see
last page for details of commonly used/required PPE).
Know the location of eye wash/emergency showers.
Know the location of first aid kits and the local first aid
providers.
Use undamaged original container or containers
appropriate to hold chemical.
Disposal
1 x 3 x 50
Inhaltion
El
Purchase required quantities only to eliminate waste.
● Skin (absorption
= 150
Corrosive to skin and eyes
A
● Eye
● Ingestion
Low
Fire
Is
Use the University of Melbourne preferred hazardous
waste contractor.
● Injection
● Other
Some organic peroxides are sentaitve movement and
friction.
T
Store in dedicated area prior to disposal.
● Inhalation
Low
Local area emergency procedures.
Restricted access.
safety.unimelb.edu.au
HEALTH & SAFETY: CHEMICAL RISK ASSESSMENT FORM – CLASS 5.2 ORGANIC PEROXIDES 5
Template date: June 2015 Version: 1.0 Authorised by: Associate Director, Health & Safety Next Review: June 2018
© The University of Melbourne – Uncontrolled when printed.
STEP 4 – IMPLEMENTATION AND CONSULTATION PROCESS
Determine the person responsible for reviewing and implementing the risk assessment including the identified controls. Ensure a Health & Safety Action Plan has been completed, reviewed and signed off where
proposed controls have been identified.
Obtain the authorisation of the management representative.
Ensure the HSR (if applicable) has been consulted. Ensure the employees undertaking the activity have been consulted.
Record below the names of the persons consulted.
Management representative
HSR/Employee representative
Employee(s)
Employee(s)
Employee(s)
Employee(s)
Person Responsible for implementation or escalation
Extra writing room - use this page to enter extended comments or descriptions
Review
Review risk assessment every 3 years.
Review employee chemical procedures during workplace inspections.
Review risk assessment where there is an incident with the chemical or new information becomes available.
Review risk assessment when the MSDS/SDS is updated/reissued.
Emergency and First Aid procedures
Ensure that general first aid procedures and resources are in place and available.
First aid risk assessment and procedures that take into account the risks associated with the chemical and possible adverse outcomes.
Assess the need for refrigerated storage or other controlled temperature to stop self react.
University of Melbourne and local area emergency procedures.
Spill kits – vermiculite or attapulgite
PPE
Respiratory protection: AS/NZS 1715 Selection, use and maintenance of respiratory protective equipment
Safety Glasses: AS/NZS 1337.1 Personal eye protection. Eye and face protectors for occupational applications
Gloves: AS/NZS 2161.1 Occupational protective glove. Selection, use and maintenance
Boots: AS/NZS 2210.1-9 (series) Occupational protective footwear or sturdy footwear as per local area requirements
To eliminate injuries always use the chemical in accordance with the manufacturer’s instructions and for its intended purpose only.
All chemical users must have demonstrated competency and be familiar with the risk assessment and any SOPs prior to use of the chemical.
For use in conjunction with the OHS risk management procedure and the Chemical risk management procedure.
For further information, refer to http://safety.unimelb.edu.au/tools/risk/ or contact your Local Health & Safety contact.
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HEALTH & SAFETY: CHEMICAL RISK ASSESSMENT FORM – CLASS 5.2 ORGANIC PEROXIDES 6
Template date: June 2015 Version: 1.0 Authorised by: Associate Director, Health & Safety Next Review: June 2018
© The University of Melbourne – Uncontrolled when printed.