Chemical Procedure Form
Hazard Identification & Risk Assessment Form
Location:
Area:
Risk Assessor (s):
Assessment Date:
Title of Project:
Reassessment Due:
/ /
/ /
Title of Procedure:
Frequency of
procedure:
Duration of
procedure:
Note: Risk Assessments are only valid for 5 years. If the procedure or risk changes a new assessment is required.
Process/Procedure Description and Substance Use
REFER TO MSDS’S AVAILABLE IN CHEMWATCH TO COMPLETE RISK ASSESSMENT
Chemical
Hazardous
Substance?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Dangerous
Goods Class
Poison
Schedule
Volume/Quantity
Used
Stored
All Hazardous Substances and Dangerous Goods must be listed and must have an MSDS.
Are any of the chemicals known carcinogens?
Are there any radiation sources? Refer to ionizing radiation safety manual requirements.
Hazardous Substance Risk Assessment
Yes
No
Yes
No
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Physical Hazard Assessment
Boiling Points:
Flash Points:
Explosion Limits: Lower Limit:
Handling considerations:
Upper Limit:
Specify:
Yes No
Storage Considerations:
Specify:
Yes No
What waste will be generated?
Specify:
Yes No
Disposal considerations?
Specify:
Yes No
Chemical Hazard Assessment
Stability:
Yes No
Flammability:
Yes No
Reactivity:
Yes No
Toxicological Hazard Assessment (Personal Health Effects)
How can exposure occur?
Skin: 
Eyes: 
(eg Solid; Aerosol; Liquid)
(eg Dust; Aerosol; Liquid)
Inhalation: 
Ingestion: 
(eg Vapour; Gas; Aerosol;
Dust)
(eg Dust; Aerosols; Liquid;
Hygiene)
Injection: 
(eg Pressure; Sharps)
Who could be potentially exposed?
What are the relevant exposure limits
of the chemicals used?
What are the potential health effects of
exposure?
Acute Effects(immediate):
Chronic Effects(Long term):
Hazardous Substance Risk Assessment
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Additional hazards (eg. radiological, mechanical, ergonomic, electrical etc.)
Risk Assessment (List identified hazards and detail measures taken to address the hazards)
Controls to be considered should include
1. Elimination (is it necessary)
2. Substitution (is there a less hazardous alternative)
3. Isolation (restrict access, perform in closed vessel)
4. Engineering (use fume cupboard)
Identified Hazards
5. Administration (training. SOP’s, use &
store minimum quantities)
6. PPE (gloves, respirator)
7. Emergency Equipment (spill kit, fire
blanket etc)
Risk assessment
Consequences
Risk Rating
Required Controls
Controls
Implemented
Likelihood
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Biological Monitoring/Health Surveillance (Required? If so provide details?)
Risk Summary (Considering the hazards and controls what is the risk rating?)




1. Risks are not significant and are likely to remain this way.
2. Risks are significant but are adequately controlled.
3. Risks are significant and require improved controls.
4. There is uncertainty about risks and/or further information is required.
If a ranking of 3 or 4 is assigned then the procedure cannot be approved. Review control measures.
Comments:
Additional controls are required to be transferred to local action plan.
Signature:
Date:
Assessment Approval:
I am satisfied that the risks are not significant and/or adequately controlled.
Supervisors Name:
Hazardous Substance Risk Assessment
Assessors Signature:
Date:
Signature:
Date:
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