CHEMICAL RISK ASSESSMENT FORM
WITHOUT AN OHS ACTION PLAN
Ra No.: [Local area RA
number if applicable]
Date: [Date RA authorised]
Version No.: [Version number
of the RA]
Review Date: [Date RA due for
review]
Authorised by: [Position title of person authorising the RA]
STEP 1 – ENTER INFORMATION ABOUT THE ACTIVITY/TASK, ITS LOCATION AND THE PEOPLE COMPLETING THE RISK ASSESSMENT
Location name:
Building No.:
Room No.:
Date:
Assessed by:
[Name]
[Number]
[Number]
[Date]
[Name/s]
Chemical (Manufacturer’s name and product name):
Is the chemical a hazardous substance?
Class 8 corrosive substances
Yes
If “yes” list the dangerous goods class:
Is the chemical a dangerous good?
Yes
No
No
Yes
[Name]
If “yes” list the hazard statement:
R34, R35
If “yes” list the poison schedule:
Is the chemical a scheduled poison?
8
Health and Safety Rep.:
No
Description of work/activities/use:
Substances that will cause severe damage when in contact with living tissue such as hydrochloric acid and sodium hydroxide. [describe activity]
Are there any licensing/permit requirements?
Yes
If “yes” provide details:
A current MSDS is available
(< 5 years old):
No
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?
Store in a Class 8 storage cabinet that complies with AS 3780.
Health surveillance requirements (list “nil” if not required):
Nil
What are the waste/disposal requirements?
Use the University waste procedure and the preferred hazardous waste contractor
List systems of work for the use of the chemical:
Chemical management training
Training procedure
Inspections
Chemical handling SOPs
SOPs
Existing controls
Scheduled bi-monthly lab inspections
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 3780 The storage and handling of corrosive substances
Training
Incident Investigation
Uni 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
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
safety.unimelb.edu.au
Neutralising agent
Restrict access
Sodium hydrogen carbonate or sodium carbonate anhydrous as neutralizers.
CHEMICAL RISK ASSESSMENT FORM WITHOUT AN OHS ACTION PLAN 1
Template date1 November 2013 Version: 1.0 Authorised by: Director, OHS and Injury Management Next Review 1 November 2016
© 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
Exposure
E
Continuously or many times daily
10
Frequently: Approximately once daily
6
Occasionally: Once a week to once a month
3
Infrequently: Once a month to once a year
2
Once every 10 years
Rarely: Has been known to occur
1
Very rarely: Not known to have occurred
0.5
Likelihood (Probability)
Level
Descriptor
Description
Expected to occur
A
Almost certain
The event will occur on an annual basis
B
Likely
The event has occurred several times or more Once every three years
in your career
C
Possible
Once a year or more
The event might occur once in your career
D
Unlikely
The event does occur somewhere from time
to time
Once every 30 years
E
Rare
Heard of something like the event occurring
elsewhere
Once every 100 years
(2) Definitions of likelihood variables
(2) Definitions of consequence labels
Consequences types
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
Severity level
Health and safety
Natural environment
Remotely possible: A possible coincidence (e.g. 1 in 100)
1
V
One or more fatalities and/or severe
irreversible disability to one or more people
Very serious, long-term environmental
impairment of ecosystem functions
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
Catastrophe
IV
Major
Extensive injury or impairment to one or more
persons
III
Short term disability to one or more persons
Serious medium-term environment effects
Insignificant
Medical treatment and/or lost injury time <2
weeks
Moderate, short-term effects but not
affecting ecosystem functions
I
First aid treatment or no treatment required
Minor effects on biological or physical
environment
(3) Definitions of consequence variables
II
Negligible
(3) Risk rating matrix
Likelihood
Consequences 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
safety.unimelb.edu.au
Adapted from HB 436: Risk management guidelines
Moderate
Consequence
C
Catastrophe: Multiple fatalities, permanent extensive environmental damage
100
Disaster: Fatality, permanent local, damage to environment
50
Very serious: Permanent disability/ill health, non-permanent environmental damage
25
Serious: Non-permanent injury or ill health. Adverse effect on environment
15
Important: Medical attention needed, off-site emission but no damage
5
Noticeable: Minor cuts and bruises or sickness, small loss of containment, no off-site
consequences
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
Low
CHEMICAL RISK ASSESSMENT FORM WITHOUT AN OHS ACTION PLAN 2
Template date1 November 2013 Version: 1.0 Authorised by: Director, OHS and Injury Management Next Review 1 November 2016
© The University of Melbourne – Uncontrolled when printed.
STEP 3 – REVIEW CHEMICAL PROCESS
For each stage of the chemical storage , use and disposal:

Check the route of exposure for each category;

Either:
o
if using the two variable risk matrix, determine and record the likelihood, consequences and the risk rating, or
o
if using the three variable risk calculator, determine and record the exposure, likelihood, consequences and the risk score.

Provide a control description for each current or proposed risk control;

Where proposed risk control(s) have been identified complete an OHS Action Plan;

Specify the risk control type from the hierarchy of control at right, for each current or proposed risk control;

Determine the residual risk score using the same two variable risk matrix or three variable risk calculator used to determine the raw sisk score.
CATEGORY
Storage
ROUTES OF EXPOSURE
Inhalation
Skin (absorption
Eye
Ingestion
Injection
RAW RISK
SCORE
CONTROL DESCRIPTION
1 x 3 x 50
= 150
Medium
CONTROL TYPE
RESIDUAL
RISK SCORE
Limit quantities in storage to as low as reasonably practicable
En
50
Store in a cabinet that complies with AS 3780
Is
Low
Restricted access
In
Regular scheduled inspections
A
2 x 3 x 50
= 300
Chemical management training
En
50
Secure to appropriate trolley for movement
A
Low
High
Limit quantities in laboratories to as low as reasonably practicable
T
Wear appropriate eye and face protection, protective clothing and gloves as per MSDS
PPE
Other – specify:
Handling
Inhalation
Skin (absorption
Eye
Ingestion
Injection
Hierarchy of Control (Control Type)
El – Elimination
S – Substitution
En – Engineering
Is – Isolation
G – Guarding
Sh – Shielding
A – Administrative
T – Training
In – Inspection
M – Monitoring
H – Health Monitoring
P – PPE
For information devising appropriate controls, refer to: The
Hierarchy of Control to Manage Chemical Risk.
Other – specify:
(CURRENT AND PROPOSED)
Other PPE as determined by activity/use and MSDS (see last page for details of commonly used PPE)
Decanting/Mixing
Inhalation
Skin (absorption
Eye
Ingestion
Injection
2 x 3 x 50
= 300
Decant in a designated decanting area – ventilation, earthing, no ignition sources.
En
90
Decanting SOP.
Is
Medium
High
Manual handling training.
A
Chemical management training.
T
Wear appropriate eye and face protection, protective clothing and gloves.
PPE
Other – specify:
Other PPE as determined by activity/use and MSDS (see last page for details of commonly used PPE).
Signage.
Applying/Using
Inhalation
Skin (absorption
Eye
Ingestion
Injection
2 x 3 x 50
= 300
Use only in a fume hood
En
90
Chemical management training
A
Medium
High
Read MSDS before using for the first time
T
Wear appropriate eye and face protection, protective clothing and gloves
In
Other PPE as determined by activity/use and MSDS (see last page for details of commonly used PPE)
PPE
Other – specify:
Workplace inspections
Spill/Leak
Inhalation
Skin (absorption
Eye
Ingestion
Injection
1 x 3 x 50
= 150
Have appropriate spill kit and cleanup equipment available
Is
50
Know local emergency procedures and evacuation routes
A
Low
Low
Know the location of eye wash/emergency showers
T
Other – specify:
Know the location of first aid kits and the local first aid providers
Use undamaged original container or containers appropriate to hold chemical
Disposal
safety.unimelb.edu.au
Inhalation
Skin (absorption
Eye
Ingestion
1 x 3 x 50
= 150
Use the University of Melbourne preferred hazardous waste contractor
A
50
Store in dedicated area prior to disposal
Is
Low
CHEMICAL RISK ASSESSMENT FORM WITHOUT AN OHS ACTION PLAN 3
Template date1 November 2013 Version: 1.0 Authorised by: Director, OHS and Injury Management Next Review 1 November 2016
© The University of Melbourne – Uncontrolled when printed.
CATEGORY
ROUTES OF EXPOSURE
Injection
Other – specify:
RAW RISK
SCORE
CONTROL DESCRIPTION
Low
Local area emergency procedures
CONTROL TYPE
(CURRENT AND PROPOSED)
RESIDUAL
RISK SCORE
T
Restricted access
STEP 4 – IMPLEMENTATION AND CONSULTATION PROCESS
Determine the person responsible for reviewing and implementing the risk assessment including the identified controls. Ensure an OHS 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 user(s) of the chemical have been consulted.
Person responsible to or escalated to
Date:
Signature of management representative
Date:
Signature of HSR/employee representative
Date:
Signature of employee(s)
Date:
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 is updated/reissued.
Emergency and First Aid procedures
Ensure that general first aid procedures and resources are in place and available. Additional specialist first aid equipment may be required. eg calcium gluconate gel for dermal contact with hydrofluoric acid.
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.
Spill kits – vermiculite or attapulgite and sodium hydrogen carbonate or sodium carbonate anhydrous as neutralizers.
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.
Health Monitoring/Screening
Nil
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 OHS practice expert.
safety.unimelb.edu.au
CHEMICAL RISK ASSESSMENT FORM WITHOUT AN OHS ACTION PLAN 4
Template date1 November 2013 Version: 1.0 Authorised by: Director, OHS and Injury Management Next Review 1 November 2016
© The University of Melbourne – Uncontrolled when printed.