टेम्प्लेट कागजातहरू अंग्रेजीमा लेखिएका छन्।

प्रणाली · 99 कागजातAir Conditioning OHS-WHS Industry Suite को भाग

Chemical Risk Assessment Form

फारम · FORM-30113

संस्करण 4

The Chemical Risk Assessment Form helps businesses identify and manage the risks associated with hazardous chemicals in the workplace. It aids in evaluating potential hazards and establishing effective safety control measures to protect workers and the environment.

It has a guidance sheet on how to use the form, a risk assessment matrix, the form that captures the substance details, safety information, inherent risks, required controls and the risk rating after controls, and sign-offs for assessors and the workers involved.

It is suitable for safety officers, managers and supervisors in industries dealing with hazardous chemicals, such as manufacturing, construction and laboratories.

यसको आफ्नै पृष्ठ हेर्नुहोस्

Hazardous Substance Risk Assessment Form

फारमVersion 4

Hazardous substance risk assessment form guidance sheet

Stage 1. Introduction

Stage 2. Hazard Identification.

Stage 3. Risk Rating

Stage 4. Risk Control

Risk assessment matrix

Likelihood	Criteria	Description

Level of effect	Example of each level

Likelihood ↑	InsignificantNo effect, or so minor that the effect is acceptable	MinorMinor first aid treatment, minimal business disruption, minimal environmental effect	ModerateSerious injuries, medium business interruption, medium environmental impact	MajorExtensive injuries or fatality, significant business interruption, environmental harm, prosecution	CatastrophicMultiple permanent disabilities or fatalities, business failure, substantial environmental harm, prosecution or imprisonment
	Consequence →
Almost certainExpected in most circumstances	2 Moderate	2 Moderate	3 High	4 Acute	4 Acute
LikelyWill probably occur in most circumstances	2 Moderate	2 Moderate	3 High	4 Acute	4 Acute
PossibleCould possibly occur at some time	1 Low	2 Moderate	2 Moderate	3 High	4 Acute
UnlikelyUnlikely but possible	1 Low	1 Low	2 Moderate	3 High	4 Acute
RareHighly unlikely to occur	1 Low	1 Low	2 Moderate	2 Moderate	3 High

1 LowRecord and monitor. Proceed with work, and review the risks regularly.
2 ModerateMaintain control measures. Be cautious when working, and monitor and review regularly.
3 HighReview before commencing work. Introduce new controls or maintain high-level controls to lower the risk level, and monitor the controls frequently.
4 AcuteDo not proceed until the risk level is reduced. Immediately introduce high-level controls, and re-assess before proceeding.

Score	Action

Hierarchy of controls

Risk assessment

Name of assessor: —
Assessor signature: —
Assessor job title: —
Assessor date: —

Approved by: —
Approved by signature: —
Approved by job title: —
Approved by date: —

Name	Signature	Date

Hazardous substance details

Hazardous Substance Name: —
Common Name: —
Container size: —
Maximum Qty to be stored: —
Supplier (Name, contact details): —

M/SDS Issued by: —
U.N Number: —
CAS Number: —
M/SDS Issue Date: —

Safety information

Activity

	Name	Initial	Date

Worker sign-off

This risk assessment has been developed in consultation and cooperation with workers and relevant Organisation. I have read the above risk assessment, and I understand its contents. I confirm that I have the skills and training, including appropriate certification, to conduct the task as described. I agree to comply with safety requirements within this risk assessment, including risk control measures, safe work instructions, and PPE.

Worker’s name	Job role / positione.g. supervisor, worker, trainee	Licences, competencies & qualificationsType / descriptionClassNumber	Date	Signature
-	-	-	-	-
-	-	-	-	-
-	-	-	-	-

यसको मार्गदर्शन र नमुना प्रविष्टिहरू लक गरिएका छन्

फारमको बनावट कस्तो छ तपाईं देख्न सक्नुहुन्छ। जुनसुकै डिभाइसमा भर्न, प्रिन्ट गर्न वा आफ्नो बनाउन यो लिनुहोस्।

एडिटर निःशुल्क चलाएर हेर्नुहोस्यो प्रणाली लिनुहोस्

ब्राउजरमा यो कस्तो देखिन्छ

यो प्रणाली लिनुहोस्

निःशुल्क साइन अप गर्नुहोस्, अनि कसरी लिने छान्नुहोस्। हरेक कागजात तपाईंको लाइब्रेरीमा, प्याकको नाम दिइएको फोल्डरमा जान्छ।

सशुल्क प्लानहरूमा समावेश
आफ्नो प्लानका टेम्प्लेट क्रेडिट प्रयोग गर्नुहोस्। यसको मूल्य 20 हो।
प्लान र मूल्य तुलना गर्नुहोस्
एकपटक किन्नुहोस्
$999.90 एकपटक तिरेपछि सधैँ तपाईंकै। निःशुल्क प्लानमा पनि चल्छ।

एडिटर निःशुल्क चलाएर हेर्नुहोस्निःशुल्क साइन अप गर्नुहोस्

साइन अप गर्न कार्ड चाहिँदैन। प्रारम्भिक पहुँच सदस्यहरूले जुनसुकै प्लानमा 30% छुट पाउँछन्।

यसले के समेट्छ

28 फिल्ड

Likelihood
Criteria
Description
Level of effect
Example of each level
Score
Action
Name of assessor
Assessor signature
Assessor job title
Assessor date
Approved by

र थप 16

टेम्प्लेटहरू कसरी काम गर्छन्

यसलाई पैसा तिर्नुअघि नै चलाएर हेर्नुहोस्।

निःशुल्क पूर्वावलोकन
हरेक टेम्प्लेटका कामका चरण, खतरा र पहिलो काम पढ्न खुला छन्। साइन अप चाहिँदैन।
एडिटर चलाएर हेर्नुहोस्
कम्प्युटर वा फोनमा, डेमो SWMS लाई आफ्नो कम्पनी, काम र साइटअनुसार मिलाउनुहोस्।
निःशुल्क साइन अप गर्नुहोस्
तपाईंको विवरण र लोगो सर्छन्। यो टेम्प्लेट विवरण भरिएरै खुल्छ।
क्रेडिट प्रयोग गर्नुहोस् वा एकपटक किन्नुहोस्
सशुल्क प्लानहरूमा हरेक महिना टेम्प्लेट क्रेडिट आउँछ। वा सधैँका लागि यो एउटा किन्नुहोस्।

Chemical Risk Assessment Form