HEALTH & SAFETY

CHEMICAL RISK ASSESSMENT FORM

Ra No.: Date: Version No.: Review Date: Authorised by:

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: HSR/Employee representative:

Chemical (Manufacturer’s name and product name): Is the chemical a hazardous substance? If “yes” list the hazard statement:
Yes No
Is the chemical a dangerous good? If “yes” list the dangerous goods class: Is the chemical a scheduled poison? If “yes” list the poison schedule:
Yes No Yes No
Description of work/activities/use:

Are there any licencing/permit requirements? If “yes” provide details: Health surveillance requirements (list “nil” if not required): A current MSDS/SDS is available
Yes 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):

What are the storage requirements? What are the waste/disposal requirements?

List systems of work for the activity/task:

● Training ● Inspections
● SOPs ● Existing controls
● Emergency situations
Is there past experience with the chemical that may assist in the assessment?
● Existing controls ● SOPs ● Standards
● Industry standards ● Incidents & near-hits ● Legislation &
Codes
● Training ● Incident Investigation ● Guidance material
First aid and emergency requirements
● Additional first aid kit contents ● Special first aid requirements (eg
oxygen)

Chemical Risk Assessment 1

Date: July 2015 Version: 1.0 Authorised by: Bio21 EHS Coordinator Review: July 2018
© The University of Melbourne – Uncontrolled when printed.
 ● Emergency eyewash ● Emergency shower
● Spill kit ● Neutralising agent ● Restrict access

Chemical Risk Assessment 2

Date: July 2015 Version: 1.0 Authorised by: Bio21 EHS Coordinator Review: July 2018
© 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

Likelihood (Probability) Exposure E
Level Descriptor Description Expected to occur Continuously or many times daily 10
A Almost certain The event will occur on an annual basis Once a year or more Frequently: Approximately once daily 6
B Likely The event has occurred several times or Once every three years Occasionally: Once a week to once a month 3
more in your career Infrequently: Once a month to once a year 2
C Possible The event might occur once in your career Once every 10 years Rarely: Has been known to occur 1
D Unlikely The event does occur somewhere from time Once every 30 years Very rarely: Not known to have occurred 0.5
to time
E Rare Heard of something like the event occurring Once every 100 years (2) Definitions of likelihood variables
elsewhere Likelihood L

(2) Definitions of consequence labels Almost certain: The most likely outcome if the event occurs 10
Likely: Not unusual, perhaps 50-50 chance 6
Severity level Consequences
Unusual but possible: (e.g. 1 in 10) 3
V Catastrophe One or more fatalities and/or severe irreversible disability to one or more
people Remotely possible: A possible coincidence (e.g. 1 in 100) 1
IV Major Extensive injury or impairment to one or more persons Conceivable: Has never happened in years of exposure, but possible (eg 1 in 0.5
1,000)
III Moderate Short term disability to one or more persons
Practically impossible: Not to knowledge ever happened anywhere (e.g. 1 in 0. 1
II Insignificant Medical treatment and/or lost injury time <2 weeks 10,000)
I Negligible First aid treatment or no treatment required
(3) Definitions of consequence variables
(3) Risk rating matrix
Consequences C
Likelihood Consequence label Catastrophe: Multiple fatalities 100
label I II III IV V Disaster: Fatality 50
A Medium High High Very high Very high Very serious: Permanent disability/ill health 25
B Medium Medium High High Very high Serious: Non-permanent injury or ill health 15
C Low Medium High High High Important: Medical attention needed 5
D Low Low Medium Medium High Noticeable: Minor cuts and bruises or sickness 1
E Low Low Medium Medium High

Chemical Risk Assessment 3

Date: July 2015 Version: 1.0 Authorised by: Bio21 EHS Coordinator Review: July 2018
© The University of Melbourne – Uncontrolled when printed.
(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 4

Date: July 2015 Version: 1.0 Authorised by: Bio21 EHS Coordinator Review: July 2018
© The University of Melbourne – Uncontrolled when printed.
STEP 3 – REVIEW CHEMICAL PROCESS
For each stage of the chemical risk assessment: Hierarchy of Control (Control Type)
 Review the prompts/examples for each route of exposure for each category; El – Elimination
 Determine and record a raw risk score by referencing the two variable risk matrix or the three variable risk calculator; S – Substitution
 In the comments box, describe the route of exposure and any other information (if applicable); En – Engineering Is – Isolation G – Guarding
 Specify the risk control type for each current or proposed risk control; Sh – Shielding
 Provide a control description for each current or proposed risk control; A – Administrative T – Training In – Inspection
 Where proposed risk control(s) have been identified complete a Health & Safety Action Plan; M – Monitoring H – Health Monitoring
 Determine the residual risk score referencing the same two variable risk matrix or three variable risk calculator used to determine the P – PPE
raw risk score. For information devising appropriate controls, refer to: Guide to
Chemical Risk Hierarchy of Control.

Category Raw Comments (when/where the exposure is present) Control Type Control Description Residual
Risk Score (Current and Proposed) Risk Score
Storage
● Inhalation ● Skin (absorption
● Eye ● Ingestion
● Injection ● Other

Handling
● Inhalation ● Skin (absorption
● Eye ● Ingestion
● Injection ● Other

Decanting/Mixing
● Inhalation ● Skin (absorption
● Eye ● Ingestion
● Injection ● Other

Applying/Using
● Inhalation ● Skin (absorption
● Eye ● Ingestion
● Injection ● Other

Spill/Leak
● Inhalation ● Skin (absorption
● Eye ● Ingestion
● Injection ● Other

Chemical Risk Assessment 5

Date: July 2015 Version: 1.0 Authorised by: Bio21 EHS Coordinator Review: July 2018
© The University of Melbourne – Uncontrolled when printed.
Category Raw Comments (when/where the exposure is present) Control Type Control Description Residual
Risk Score (Current and Proposed) Risk Score
Disposal
● Inhalation ● Skin (absorption
● Eye ● Ingestion
● Injection ● Other

STEP 4 – IMPLEMENTATION AND CONSULTATION PROCESS

Determine the person responsible for reviewing and implementing the risk assessment including the identified controls. Ensure a Health & Safety 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 employees undertaking the activity have been consulted.
Record below the names of the persons consulted.
Research Group Leader HSR/Employee representative
Employee(s) Employee(s)
Employee(s) Employee(s)
Person Responsible for implementation or escalation

Extra writing room - use this page to enter extended comments or descriptions

For use in conjunction with the OHS risk management procedure and the Chemical risk management procedure.
For further information, refer to [Link] or contact your Local Health & Safety contact.

Chemical Risk Assessment 6

Date: July 2015 Version: 1.0 Authorised by: Bio21 EHS Coordinator Review: July 2018
© The University of Melbourne – Uncontrolled when printed.