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    Health & Safety Risk Assessment Form

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    Carmen M Avinazar
    This document provides a template for conducting a chemical agents risk assessment in the workplace. It is comprised of three parts. Part one involves identifying basic information about the risk source and exposure. Part two involves classifying the chemical's hazards using pictograms from the CLP regulation. Part three involves documenting existing controls, additional required controls, and assigning a risk owner to address risks by a due date. The assessment is intended to comply with regulations requiring the identification, assessment and control of risks from chemical agents.

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    Health & Safety Risk Assessment Form

    Uploaded by

    Carmen M Avinazar
    47 views4 pages
    This document provides a template for conducting a chemical agents risk assessment in the workplace. It is comprised of three parts. Part one involves identifying basic information about the risk source and exposure. Part two involves classifying the chemical's hazards using pictograms from the CLP regulation. Part three involves documenting existing controls, additional required controls, and assigning a risk owner to address risks by a due date. The assessment is intended to comply with regulations requiring the identification, assessment and control of risks from chemical agents.

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    chemicalagentsriskassessmentform

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    This document provides a template for conducting a chemical agents risk assessment in the workplace. It is comprised of three parts. Part one involves identifying basic information about the risk source and exposure. Part two involves classifying the chemical's hazards using pictograms from the CLP regulation. Part three involves documenting existing controls, additional required controls, and assigning a risk owner to address risks by a due date. The assessment is intended to comply with regulations requiring the identification, assessment and control of risks from chemical agents.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    47 views4 pages

    Health & Safety Risk Assessment Form

    Uploaded by

    Carmen M Avinazar
    This document provides a template for conducting a chemical agents risk assessment in the workplace. It is comprised of three parts. Part one involves identifying basic information about the risk source and exposure. Part two involves classifying the chemical's hazards using pictograms from the CLP regulation. Part three involves documenting existing controls, additional required controls, and assigning a risk owner to address risks by a due date. The assessment is intended to comply with regulations requiring the identification, assessment and control of risks from chemical agents.

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    National Health and Safety Function, Workplace Health and Wellbeing Unit, National HR Division

    Health & Safety Risk Assessment Form

    Ref: CF:003:04 RE: Chemical Agents Risk Assessment Form


    Issue date: November 2017 Revised Date: June 2020
    Author(s): National Health & Safety Function
    Legislation Under the Safety, Health and Welfare at Work (Chemical Agents) Regulations, 2001 it is the duty of the employer to identify the
    hazards and assess the risks associated with the use of chemical agents in the workplace. All risk assessments must be in writing and
    the necessary control measures to eliminate or minimise the risks documented and implemented.
    Note: Please note exposure to COVID-19 may present a health risk to staff and others at our places of work. It is essential that the latest
    public health advice is followed and suitable control measures identified and implemented to mitigate the risk of COVID-19 infection.

    When conducting Chemical Agent risk assessments consideration should be paid to the risk presented and the means of avoiding and
    mitigating any such risk so far as is reasonably practicable .

    Where 2 metre worker separation cannot be ensured a specific activity risk assessment must be conducted and alternative protective
    measures must be put in place e.g. comprehensive hygiene measures, minimising the frequency and time staff are within 2 metres of
    each other, minimising the number of staff involved in the task, physical barriers, provision of face masks.

    It is responsibility of local management to implement any remedial actions identified.

    20 06 30 CF: 003:04 Health and Safety Risk Assessment - Chemical Agents Page 1
    National Health and Safety Function, Workplace Health and Wellbeing Unit, National HR Division

    Chemical Agents Risk Assessment – Part 1 of 3


    Division: Source of Risk:
    HG/CHO/NAS/Function: Primary Impact Category:
    Hospital Site / Service: Risk Type:
    Dept/Service Site: Name of Risk Owner (BLOCKS):
    Date of Assessment: Signature of Risk Owner:
    Unique ID No: Risk Co-Ordinator:
    *Risk Assessor(s):

    Chemical Name (Concentration): Chemical Process:

    Number of Employees
    Categories of employees likely to be exposed: (Tick) Duration and frequency of contact (Hr/day):
    Exposed:
    Nursing Staff Medical Staff
    Care Staff Maintenance Staff
    Housekeeping Others (please specify):
    Safety Data Sheet available: Yes No Location of SDS : Date of SDS:
    Amount used and Dustiness or Volatility: High, Medium or
    Hazard and risk associated with chemical: Exposure route(s) (Tick):
    quantity stored Low
    Eyes
    Skin
    Ingestion
    Inhalation

    20 06 30 CF: 003:04 Health and Safety Risk Assessment - Chemical Agents Page 2
    National Health and Safety Function, Workplace Health and Wellbeing Unit, National HR Division

    Chemical Agents Risk Assessment – Part 2 of 3


    Classification, Labelling and Packaging (CLP) Hazard Symbols
    CLP SYMBOLS

    Acute Serious Health Corrosion Environme Flammabilit Oxidising Explosion Stored as


    toxicity long term hazard Hazard ntal hazard y hazard Hazard Hazard gas under
    hazard health pressure
    hazard
    Tick appropriate pictogram.
    Refer to section 2 of SDS

    Insert appropriate signal word


    i.e. danger or warning. Refer to
    section 2 of the SDS

    Occupational Exposure Limit Value (OELV) If applicable insert airborne OELV :_____________________

    Refer to Code of Practice to Chemical Agents Regulations

    20 06 30 CF: 003:04 Health and Safety Risk Assessment - Chemical Agents Page 3
    National Health and Safety Function, Workplace Health and Wellbeing Unit, National HR Division

    Chemical Agents Risk Assessment – Part 3 of 3


    ACTION
    ADDITIONAL CONTROLS OWNER (i.e. the DUE DATE
    **HAZARD & RISK DESCRIPTION EXISTING CONTROL MEASURES
    REQUIRED Person responsible
    for the action)

    INITIAL RISK Risk Status


    Likelihood Impact Initial Risk Rating Open Monitor Closed

    *Risk Assessor to be recorded for OSH risks only.


    **Where the risk being assessed relates to an OSH risk please ensure that the HAZARD and associated risk are recorded on the form. All other risk assessments require a risk description
    only.

    20 06 30 CF: 003:04 Health and Safety Risk Assessment - Chemical Agents Page 4

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