Page | 1 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 Page | 2 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 Document1 Page | 3 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 Document1 Page | 4 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 Document1 Page | 5 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 Document1 L R Cost of controls (in terms of time, effort, money) Is this reasonably practicable Y/N Page | 6 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 Document1 Signature Date