Hazardous Substance Risk Assessment Form

HAZARDOUS SUBSTANCE RISK ASSESSMENT FORM This document fulfils the requirements of the COSHH and DSEAR Regulations relating to a written risk assessment When completing form, refer to Guidance Notes Experiment / Procedure / Process / Activity / Demonstration (include a brief description): | |Frequency (hourly, daily, weekly, monthly or ‘one-off’): | |Hazardous substances to be used (List ALL substances including solvents, expected products and by-products): | |Can any of the substances be substituted with a less hazardous substance or form of the substance?YES / NO | |If yes, you must do so, or justify not using it. ___________________________________________________________________ | |Substance |Approx.

Physical Form |Hazards | |Risk Phrases / GHS |Exposure Route(s) | | |quantity |gas, liquid, |Toxic, flammable, |WEL |Hazard Statements |inhalation, ingestion, | | | |solid, dust |corrosive, irritant, |Work |(see guidance note |injection, absorption | | | | |easily absorbed |Place |lists) | | | | | |through skin etc |Exp | | | | | | | |Limit | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |Which are the significant chemical hazards? ___________________________________________________________ | |Risks associated with the procedure: (non-chemical risks may require an additional risk assessment) | |Note: DSEAR risk considerations include: | |Is there any substance used or formed that might give rise to a fire or explosion (e. g. reactive intermediates)? y/n | |If yes, how will you ensure that no fire or explosion occurs (inc. the consideration of eliminating ignition sources): | |Is it reasonably foreseeable that the lower explosive limit will be reached in the event of a leak / spillage? /n | |If yes, a more detailed risk assessment is required under the Dangerous Substances Explosive Atmospheres Regulations.

| |Are any of the substances a Category 1 or 2 carcinogen, a mutagen, a substance toxic to y/n | |reproduction, a respiratory sensitizer or a skin sensitizer? | |(Risk Phrases: R42, R43, R45, R46, R49, R60, R61, R64 or Hazard Statements: H334, H317, H350, H340, H350i, H360f, H360d, H362) | |Work with these compounds must be carried out in a fume cupboard where reasonably practicable. A health record must be completed. |Control Measures: | |Containment: |Personal Protective Equipment: | |Fume cupboard | | |Lab coat / overalls | | | |Glove box / isolator | | |Gloves | | | |Safety cabinet | | |Glove type: |___________________ | |Local exhaust ventilation | | |Eye Protection (i. e. afety | | | | | | |glasses, goggles, face shield) | | | |Additional: | | |type: |___________________ | |Storage requirements (specify): | |Respiratory protective equipment | | | | |____________________ |(RPE) * | | | |Other control measure (specify): | |RPE type: | | | |____________________ | |___________________ | | | | |* Under COSHH all RPE requires face-fit testing | |Is health surveillance required? /n | | | | |Monitoring: Gas, Vapour or Dust y/n Specify what and how : |_________________________________________ | |Are any additional controls required not covered above? (training, instruction, information or maintenance) | | | |Are there additional non-chemical hazards requiring further risk assessment? y/n Ref No: | |Waste Disposal Routes: Refer to University and departmental policy. | |Consider segregation, containment and appropriate labelling of waste in order to avoid problems of mixing incompatible wastes.

|Chlorinated solvent | |Aqueous (hazardous) |Other (specify): ____________________ | |Non-chlorinated solvent | |Aqueous (non-hazardous) | | | |Identify incompatible wastes: _______________________________________________________________________________ | |NB: The mixing of incompatible wastes can introduce significant additional hazards, consult literature and MSDSs | |Emergency Procedures (emphasise any special hazards): | |Fire Extinguisher: |CO2 | |Dry Powder | |L2 D-metal | | |Spillage/Uncontrolled Release: |Spill Kit | |Evacuate Area | |Wash Down Area | | |Other (specify): __________________________________________________________________________________________ | |What could happen if there was catastrophic failure of the apparatus? _______________________________________________ | |In the event of an accident, who might be exposed? ____________________________________________________________ | |Emergency Treatment in Case of Contamination or Exposure: | |Exposure/Contamination – standard procedures (special procedures MUST be detailed below) Read and Understood | |Mouth, Eyes, Skin Exposure – flush area of contact with plenty of water, contact a First Aider; Lungs – remove to fresh air, contact a First Aider. If | |swallowed – contact a First Aider, get details of substance ingested and seek medical attention immediately. | |If casualty unconscious – contact a First Aider immediately and call an ambulance. | |Other (specify): _____________________________________________________________________________