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HS RISK MANAGEMENT FORM
FOR EXPERIMENTS OR
ACTIVITIES
School of Chemical Engineering
RISK MANAGEMENT MUST BE CARRIED OUT and submitted for any activity / experiment associated with
the School. Submit to Sandra Twomey, Room 310, Level 3, Chemical Sciences Building.

YOU MUST UPDATE AND RESUBMIT YOUR RISK MANAGEMENT if you change your activity, experimental
procedure, materials or equipment in any way.

FOR LONGER TERM PROJECTS OF MORE THAN 1 YEAR, your Risk Management must be updated and
resubmitted every 12 months.

As an additional help with your risk management writing, a list of Safe Working Procedures (SWP), Risk
Management (RM) templates and Manuals are available from the SWP & RM Register to assist you:
https://plantreg.ceic.unsw.edu.au/login.asp


These templates can be used as they are or as a guide for completing this risk management form.
Any templates used from the Register, whether original or modified must be printed, reviewed and signed by
your Supervisor and included as an Appendix to this risk management form and a copy filed in your white
safety folder.
Study /
Degree
(Underline)
Masters /
PhD
(Res)
4th yr
Honours
UG /
Summer Res /
Industrial
Training
Masters
(C/wk)
Practicum
Res Fellow /
Res Assistant /
Postdoc
TITLE OF EXPERIMENT OR ACTIVITY
Initial Risk Management
Updated Risk Management
(the first Risk Management you do for a project)
(if a component changes within 12 months)
WRITTEN BY (YOUR NAME)
First Name(s)
Family Name
Student / Staff Number
Internal:
Contact Phone Number(s)
Email Address
Laboratories to be used
Experiment start date
For office use only:
RM Reference No
Electronic copy filed on server
Safety declaration / Ind Checklist
Induction forms HS006 / HS049
Undertaken LABSAF / LSAO
Controlled Document
Document1
Mobile: (optional)
Experiment end date
Visitor /
Academic Staff
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HS026
1. Completed by
Safe work procedure
___________________
_____________
Staff/Student number
The Safe Work Procedures Guideline (HS027) should be consulted to assist in the completion of this form
http://www.ohs.unsw.edu.au/hs_procedures_forms/guidelines/HS027_Safe_work_procedures_guideline.pdf
Faculty/Division:
School/Unit:
ENGINEERING
SCHOOL OF CHEMICAL ENGINEERING
Document number
HS026_CHE_RMT
Initial Issue date
Current version
Current Version Issue date
Next review date
__21/02/2014__
_____Vs 2_____
_____21/02/2014___
___21/02/2015_
2.Safe work procedure title and basic description of activity
Title:
Description of activity:-
3.List hazards and risk controls as identified during risk management
Associated risk
assessment
number and
location:
Hazards
Controls
Complete these details on the Risk Management Form HS017 in this document.
4.List resources required including personal protective clothing, chemicals and equipment needed
Helper:
List chemicals you are using and refer to Safety Data Sheets (SDS) to determine level of personal protective clothing
(PPE) / equipment and laboratory resources you will require
Search SWP and RM Register for documents required for your activity / experiment (if available)
List SWP numbers / RM number / manual name
For example if you are handling chemicals and using a centrifuge refer to:
SWP_CHE_0051_Hazardous substances-handling and transportation procedures and SWP_CHE_0480_centrifuge
5.List step by step instructions or order for undertaking the task
6.List emergency shutdown procedures
7.List emergency procedures for how to deal with fires, spills or exposure to hazardous substances
Emergency response checklist (tick if applicable)
I have read and understood:
☐ UNSW Emergency procedure booklet
☐ All relevant chemical Safety Data Sheets
(SDS)
☐ Hazardous substance – handling and
transportation (SWP_CHE_0051)
☐ Chemical spill control procedure
(SWP_CHE_0052)
☐ Biological Spill control procedure
(SWP_CHE_0071)
List location of the nearest:
☐ Safety shower and eyewash:
Click here to enter text.
☐ First aid kit and first aid officer:
Click here to enter text.
☐ Spill control kit:
Click here to enter text.
☐ Fire extinguisher and fire blanket:
Click here to enter text.
☐ Breathing apparatus and trained personnel:
Click here to enter text.
Controlled Document - HS026 safe work procedure Version: 3.1, 23/01/2013
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8.List clean up and waste disposal requirements
Waste disposal checklist (tick if applicable):
I have read and understood:
☐ UNSW Hazardous Waste Disposal Guideline
(HS321)
☐ Disposing of Empty Chemical Bottles
(SWP_CHE_0057)
List location of the nearest:
☐ Solid and liquid waste containers:
Click here to enter text.
☐ Broken glass bin and sharps bin:
Click here to enter text.
9.List legislation, codes of practice, manufacturers manual, industry standards etc used in the
development of this SWP
Work Health and Safety Act 2011
Work Health and Safety Regulation 2011
10a.List competency required – qualifications, certificates, licensing, training - e.g. course or
instruction:
Helper:
Laboratory Safety Awareness Training and list other courses as required. Refer to the Health & Safety Training
Requirements document found in the white safety folder
10b. List competency of assessor
By signing below at Point 11 the Supervisor acknowledges that they have the necessary experience / qualifications
outlined in this SWP / RM document.
Any specific competencies / qualifications can be listed.
11.Supervisory approval, and review
Supervisor:
Name:
Signature:
____________________________________
Date:
_______________________
Responsibility for SWP review:
Date of review: _______________________
(Risk Management Author to review)
(experiment end date)
Controlled Document - HS026 safe work procedure Version: 3.1, 23/01/2013
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HS017
HS Risk management form
For additional information refer to HS329 Risk Management Procedure
http://www.ohs.unsw.edu.au/hs_procedures_forms/procedures/HS329_Risk_Management_Procedure.pdf
Faculty/Division:
ENGINEERING
School/Unit:
SCHOOL OF CHEMICAL ENGINEERING
Document number
Initial Issue date
Current version
Current Version Issue date
Next review date
HS017_CHE_RMT
____21/02/2014_______
___ Vs 2_______________ _____21/02/2014_______
__21/02/2015__
Risk management name
Form completed by: _____________________
Signature:
Date:
Signature:
Date:
ID Number:
(Risk Management Author to sign here)
Responsible supervisor / authorising officer
Name:
Identify the activity and the location of the activity
Description
of activity
Identify who may be at risk from the activity:
Description
of location
Persons at risk
LIST LABORATORIES TO BE USED
This may include fellow workers, visitors, contractors and the public. The types of people
may affect the risk controls needed and the location may affect the number of people at risk
How they were
consulted on the risk
OTHER LAB USERS
ACCESS TO WHITE FOLDER
List legislation, standards, codes of practice, manufacturer’s guidance etc used to determine control measures necessary
Work Health and Safety Act 2011
Work Health and Safety Regulation 2011
REFER TO HS026 SAFE WORK PROCEDURE Section 9
HS Risk Management Form Version 3.5 23rd April 2013
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Identify hazards and control the risks
1. An activity may be divided into tasks. For each task identify the hazards and associated risks. Also list the possible scenarios which could sooner or later cause harm
2. Determine controls necessary based on legislation, codes of practice, Australian standards, manufacturer’s instructions etc.
3. List existing risk controls and any additional controls that need to be implemented
4. Rate the risk once all controls are in place using the matrix in HS329 Risk Management Procedure
SHADED GREY AREAS
If you need to determine whether it’s reasonably practicable to implement a control, based on the risk complete the shaded grey columns
Feel free to resize the boxes to suit your situation/the amount of text you need to use
Task/
Scenario
Hazard
Associated
harm
Existing controls
Any additional controls
required?
Risk Rating
C




HS Risk Management Form Version 3.5 23rd April 2013
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L
R
Cost of controls
(in terms of time,
effort, money)
Is this
reasonably
practicable
Y/N
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List emergency procedures and controls
List emergency controls for how to deal with fires, spills or exposure to hazardous substances and/or emergency shutdown procedures
Note position of emergency brochure (read and understand), fire extinguishers, fire blankets, safety showers, first aid kits, spill control kit, fume cupboards, phone,
safety folders and other emergency apparatus.
Implementation
Additional control measures needed:
Resources required
Responsible person
Date of implementation
REVIEW (ACADEMIC SUPERVISOR)
Are all control measures in place?
Are controls eliminating or minimising the risk?
Are there any new problems with the risk?
Review by: (Academic Supervisor)
Review date: experiment end date
(No longer than 12 months)
Acknowledgement of Understanding
All persons performing these tasks must sign that they have read and understood the risk management (as described in HS329 Risk Management Procedure).
Note: for activities which are low risk or include a large group of people (e.g. open days, BBQ’s, student classes etc), only the persons undertaking the key activities need to sign below. For all others involved in such
activities, the information can be covered by other methods including for example a safety briefing, induction, and/or safety information sheet (ensure the method of communicating this information is specified here)
Risk management name:
I have read and understand this Risk Management Form (Risk Management Author to sign here)
Name
HS Risk Management Form Version 3.5 23rd April 2013
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Signature
Date