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.:
Date:
Chemical (Manufacturer’s name and product name):
Is the chemical a hazardous substance?
Yes
Class 2.3 toxic gases
Is the chemical a dangerous good?
Yes
If “yes” list the dangerous goods class:
No
Assessed by:
If “yes” list the hazard statement:
No
H280, H270, H330, H314 EUH701 (example for
flourine)
Is the chemical a scheduled poison?
2.3
Yes
HSR/Employee representative:
If “yes” list the poison schedule:
No
7
Description of work/activities/use:
Gases that can cause death or serious injury if inhaled; such as fluorine, chlorine, and hydrogen cyanide
Are there any licencing/permit requirements?
Yes
No
If “yes” provide details:
Health surveillance requirements (list “nil” if not required):
Normally not required, however the use of some high
concesquence dangerous goods may require a permit.
Refer to the Chemeical Management Guidelines
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):
The room is a purpose bult gas store with 1 door that complies with AS 4332. The storage and handling of gases in cylinders. It has natural ventilation.
What are the storage requirements?
What are the waste/disposal requirements?
Compliance with AS 4332 The storage and handling of gases in cylinders.
Initially place “empty” cylinder in the gas store designated area for empty cylinders. Return ‘empty’ cylinder
or unwanted gas to the original supplier.
List systems of work for the activity/task:
Compressed gas safety training
● Training
● Inspections
Handling and use of toxic gas SOP
● SOPs
● Existing controls
Scheduled bimonthly workplace inspections
● Emergency situations
Dedicated storage location
Is there past experience with the chemical that may assist in the assessment?
Compressed gas safety training
● Existing controls
● SOPs
● Standards
Handling and use of flammable gas SOP
● Industry standards
● Incidents & near-hits
● Legislation & Codes
AS 4332 The storage and handling of gases in cylinders. Dangerous Goods (Storage and Handling) Regulations 2012
● Training
● Incident Investigation
● Guidance material
OHS Act 2004. OHS Regulations 2007
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HEALTH & SAFETY: CHEMICAL RISK ASSESSMENT FORM CLASS 2.3 – TOXIC GASES 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.
University of Melbourne chemical management guidance material. Chemical risk management procedure
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
● Spill kit
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● Neutralising agent
● Restrict access
HEALTH & SAFETY: CHEMICAL RISK ASSESSMENT FORM CLASS 2.3 – TOXIC GASES 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
safety.unimelb.edu.au
Low
HEALTH & SAFETY: CHEMICAL RISK ASSESSMENT FORM CLASS 2.3 – TOXIC GASES 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
Is – Isolation
G – Guarding
In – Inspection
H – Health Monitoring
For information devising appropriate controls, refer to: Guide to
Chemical Risk Hierarchy of Control.
Comments (when/where the exposure is present)
Control Type
Control Description
(Current and Proposed)
Residual
Risk Score
Low
1 x 1 x 50
Inhalation associated with poor ventilation
En
● Inhalation
● Skin (absorption
= 50
Absorption through the skin
Is
Cylinders in a purpose built storage facility as per first
page:
● Eye
● Ingestion
Low
Explosion
In
• Well ventilated area
● Injection
● Other
A
Restricted access.
P
Regular scheduled inspections.
Cylinders secured in an upright position.
Full and empty cylinders separated.
Store away from direct sunlight.
Other PPE as determined by activity/use and MSDS/SDS
(see last page for details of commonly used/required
PPE.
Handling
1 x 3 x 50
Inhalation associated with poor ventilation
En
● Inhalation
● Skin (absorption
= 150
Absorption through the skin
A
Secure to cylinder trolleys in an upright postion for
movement.
● Eye
● Ingestion
Medium
Explosion
T
Cylinder handling SOP.
● Injection
● Other
Manual handling associated with movement of large
cylnders
P
Manual handling training.
Low
Compressed gas cylinder raining
Leather rigging gloves when handling cylinders.
Closed sturdy shoes.
Decanting/Mixing
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Nil
HEALTH & SAFETY: CHEMICAL RISK ASSESSMENT FORM CLASS 2.3 – TOXIC GASES 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
● Inhalation
● Skin (absorption
● Eye
● Ingestion
● Injection
● Other
Comments (when/where the exposure is present)
Control Type
Control Description
(Current and Proposed)
Residual
Risk Score
Low
Applying/Using
1 x 3 x 50
Inhalation associated with poor ventilation
En
Regulator suitable for Class 2.3 toxic compressed gases.
● Inhalation
● Skin (absorption
= 150
Absorption through the skin
A
Regulator serviced to manufacturer’s requirements.
● Eye
● Ingestion
Medium
Explosion
T
Regular inspection of O-rings or seals.
Manual handling associated with movement of large
cylnders
In
Secure cylinders in an upright position
P
Work place inspections.
● Injection
● Other
Compressed gas safety training.
PPE as determined by activity/use and MSDS/SDS (see
last page for details of commonly used/required PPE).
Reticulated systems:
• Regular inspections
Stand alone cylinder use:
• Manufacture’s/supplier’s “key” used to open cylinder
• Hosing suitable for Class 2.3 toxic compressed gases
• Hosing inspected as per manufacturer’s requirements
Spill/Leak
1 x 1 x 50
Inhalation
Is
● Skin (absorption
= 50
Absorption through the skin
A
Keep cylinder secured to trolley or wall in an upright
postion at all times
● Eye
● Ingestion
Low
Explosion
P
Know the emergency procedures and egress routes
● Injection
● Other
● Inhalation
Low
Do not use oil stripped Teflon tape to stop leaks on the
regulator – leaking cylinders/regulators should be
removed from service, appropriately stored and
arrangements to return to supplier.
Manual handling associated with movement of large
cylnders
PPE as determined by the emergency procedures (see
last page for details of commonly used/required PPE)
Disposal
1 x 1 x 50
Inhalation associated with poor ventilation
En
Return “empty” cylinder or unwanted gas to supplier.
● Inhalation
● Skin (absorption
= 50
Absorption through the skin
Is
Store in purpose built storage facility as per first page.
● Eye
● Ingestion
Low
Explosion
A
Always close the control valve on “empty” cylinders.
● Injection
● Other
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Low
HEALTH & SAFETY: CHEMICAL RISK ASSESSMENT FORM CLASS 2.3 – TOXIC GASES 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.
University of Melbourne and local area emergency procedures.
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 2.3 – TOXIC GASES 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.