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Risk Assessment Checklist
Hazardous Substances
Page 1 of 4
Date:
Location:
Cycle being
assessed
Substance Description
If use, how is the
substance used?
 Storage
 Sprayed on
 Use
 Brushed on
 Mixing
 Wiped on
 Decanting
 Dipped in
 Disposal
Manufacturer/Supplier
Material Safety Data
Sheet Number
HAZCHEM Code
Poison Schedule
UN Number
Dangerous Goods
Class
Package
Group
Evaluation Matrix
Likelihood
Very Likely (might happen sometime through the day)
Likely (might happen sometime through the week)
Unlikely(might happen sometime this month)
Very Unlikely (might happen sometime)


Critical
(Disability)
Extreme
Extreme
High
Moderate
Consequence
Major
Serious
(Lost time)
(Injury)
Extreme
High
High
Moderate
Low
Low
Moderate
Insignificant
Minor
(1st Aid)
Moderate
Low
Insignificant
Insignificant
Acute damage is damage that will happen immediately
Chronic damage is damage that happens over a longer period of time and may not be noticed for some time)
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Risk Assessment Checklist
Hazardous Substances
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Respiratory Hazards
Describe
Risk
Describe
Risk
Describe
Risk
Describe
Risk
Describe
Risk
Describe
Risk
1. Acute respiratory or inhalation problems for
operators, including exclusion of oxygen
2. Chronic respiratory or inhalation risks for
operators
3. Acute or chronic respiratory or inhalation risks
for other people in the area
Skin Irritation or Dermatitis Hazards
4. Acute or chronic skin irritation or damage to
operators
5. Any type of skin irritation or damage to others
in the area
6. Possible skin irritation to other people who
might come into contact with residue
Eye Irritation or Damage Hazards
7. Any type of eye damage to operators
8. Any type of eye damage to other people in the
area
Ingestion or Poisoning Hazards
9. Acute problems associated with swallowing,
eating or ingesting the substance
10. Chronic problems associated with swallowing,
eating or ingesting the substance
Carcinogenic, Mutagenic or other
Biological Hazards
11. Threats to operators and those with high
exposure
12. Threats to other people or those with low
exposure
Environmental Hazards and Emergency
or Storage Hazards
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Hazardous Substances
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13. Acute environmental damage
14. Long term or delayed environmental damage
15. Fire or Explosions or other chemical reactions
16. HAZCHEM or Dangerous Goods warnings and
placarding requirements
17. Storage or packaging with other substances or
in certain environments
18. Problems associated with transporting the
substance around the site
19. Poor labelling or information about the
substance
Any hazards that score a risk rating of 4 or 5 must have treatments developed.
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Risk Assessment Checklist
Hazardous Substances
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Suggested Control (Using highest level control possible)
(The identified hazard taken from the
checklist)
1.
2.
3.
No
Details
Initial Risk
Hazard
4.
5.
Eliminate the substance completely, or
Substitute the substance with a less hazardous substance, or
Re-engineer the machine using extraction or barriers so
operators do not come into contact with the substance, or
Use administrative measures like training and work
instructions, or
Provide operators with suitable personal protective equipment
such as glasses, gloves or aprons.
Does a maintenance request have to be raised to implement
the requirements? Yes / No
Assessors
Signatures
Request Number
Residual Risk
Treating Risks