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16/03/2016
School of Life and Environmental Sciences
Hazard Assessment Form
Preamble
A key requirement of work health and safety (WHS) is for the employer and the supervisor to
systematically manage risks arising from workplace hazards. There must also be effective
consultation and communication with the workers involved about these risks and how they are to
be managed.
To facilitate this process, the Safety Committee of the School of Life and Environmental Sciences
(SOLES) has developed this Hazard Assessment Form that is part of the mandatory safety
induction for all new staff, students and visitors (for more details regarding the safety induction
process see also https://intranet.sydney.edu.au/science/soles/whs.html. This document should be
updated regularly to include new tasks and procedures.
There are five steps in this form aimed at managing WHS risks at workplaces across SOLES:
1. Identify hazards and hazardous tasks
2. Recognize mechanisms to control the risks
3. Identify additional training requirements
4. Determine the overall risk level associated with a position
5. Establishing a safe work environment.
Instructions to complete the form:
 All staff, students and visitors MUST complete this form with their supervisor or line manager at
the start of their work.
 If new tasks or hazardous agents are being introduced at later times, the form is to be
appended.
 The new worker must be given the opportunity to ask questions about any hazards and risks.
 A copy of this document (and any modifications, additions) must be sent to the School’s Safety
Officer ([email protected]).
 Safe Work Procedures (SWPs) and Risk Assessments (RAs) for a number of generic tasks are
available at https://intranet.sydney.edu.au/science/soles/whs.html.
Details of new worker and supervisor:
Name of worker ……………………………………………………………………..………
Role………………………………………………………………………………………..…..
Name of supervisor(s) …………………………………………………………….……...
Primary work location(s) (building and room numbers) …………..…………………………….
Notes for PART A (see next page):
* If applicable include reference number of existing SWP or RA (https://intranet.sydney.edu.au/science/soles/whs.html).
In all other cases, a new SWP and RA must be completed for all risks rated medium or high.
** Additional additional risk assessments may be required (e.g. for fieldwork, field trips or farm work). See also
https://intranet.sydney.edu.au/science/soles/whs.html and contact the Safety officer ([email protected]).
*** All wet lab work incl. preparation and wash-up areas requires that enclosed shoes and a clean, buttoned-up, properly
fitting lab coat or gown are worn, and that any long hair is tied back.
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PART A: Complete for all hazardous tasks and procedures
Agent, Task or Scenario 1:
Risk level (use risk matrix at end of Section A to complete)
SWP and RA Number and Name*:
Nature of hazards**
(tick boxes, provide details if necessary)
Toxic ☐
Flammable ☐ Corrosive ☐
Carcinogenic / mutagenic ☐
Restricted chemical ☐ PC1 ☐ PC2 ☐
PC2-GMO microbe ☐ PC2-GMO other ☐
Animals / animal samples ☐
Humans / human samples ☐
Fieldwork / field trips ☐ Farm work ☐
Heat ☐ Cold ☐ Electrical ☐ Mechanical ☐
Radiation ☐
Other:
………………………..….………..……………….
……………………………………………..............
Risk rating (using the Risk Matrix):
Risk controls***
(tick boxes, provide details if necessary)
Gloves ☐ Type ………………………………
Safety glasses or goggles ☐
Heat-resistant gloves ☐
Fume hood ☐ Biosafety cabinet ☐
Training ☐.…………………………………….
………………………….…………..……………
Supervision ☐……….………………………..
……………………….…………………………..
Vaccination
……………………….…………………………..
Other: ...………………………………………..
………….…………….………….………………
Workers initials:
Supervisors initials:
Agent, Task or Scenario 1:
Risk level (use risk matrix at end of Section A to complete)
SWP and RA Number and Name :
Nature of hazards
(tick boxes, provide details if necessary)
Toxic ☐
Flammable ☐ Corrosive ☐
Carcinogenic / mutagenic ☐
Restricted chemical ☐ PC1 ☐ PC2 ☐
PC2-GMO microbe ☐ PC2-GMO other ☐
Animals / animal samples ☐
Humans / human samples ☐
Fieldwork / field trips ☐ Farm work ☐
Heat ☐ Cold ☐ Electrical ☐ Mechanical ☐
Radiation ☐
Other:
………………………..….………..……………….
……………………………………………..............
Risk rating (using the Risk Matrix):
Risk controls
(tick boxes, provide details if necessary)
Gloves ☐ Type ………………………………
Safety glasses or goggles ☐
Heat-resistant gloves ☐
Fume hood ☐ Biosafety cabinet ☐
Training ☐.…………………………………….
………………………….…………..……………
Supervision ☐….……………………………..
…………………………………………………..
Vaccination
……………………….…………………………..
Other: ...………………………………………..
………….…………….………….………………
Workers initials:
Supervisors initials:
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PART A: continued
Agent, Task or Scenario 1:
Risk level (use risk matrix at end of Section A to complete)
SWP and RA Number and Name :
Nature of hazards
(tick boxes, provide details if necessary)
Toxic ☐
Flammable ☐ Corrosive ☐
Carcinogenic / mutagenic ☐
Restricted chemical ☐ PC1 ☐ PC2 ☐
PC2-GMO microbe ☐ PC2-GMO other ☐
Animals / animal samples ☐
Humans / human samples ☐
Fieldwork / field trips ☐ Farm work ☐
Heat ☐ Cold ☐ Electrical ☐ Mechanical ☐
Radiation ☐
Other:
………………………..….………..……………….
……………………………………………..............
Risk rating (using the Risk Matrix):
Risk controls
(tick boxes, provide details if necessary)
Gloves ☐ Type ………………………………
Safety glasses or goggles ☐
Heat-resistant gloves ☐
Fume hood ☐ Biosafety cabinet ☐
Training ☐.…………………………………….
………………………….…………..……………
Supervision ☐….……………………………..
…………………………………………………..
Vaccination
……………………….…………………………..
Other: ...………………………………………..
………….…………….………….………………
Workers initials:
Supervisors initials:
Agent, Task or Scenario 1:
Risk level (use risk matrix at end of Section A to complete)
SWP and RA Number and Name :
Nature of hazards
(tick boxes, provide details if necessary)
Toxic ☐
Flammable ☐ Corrosive ☐
Carcinogenic / mutagenic ☐
Restricted chemical ☐ PC1 ☐ PC2 ☐
PC2-GMO microbe ☐ PC2-GMO other ☐
Animals / animal samples ☐
Humans / human samples ☐
Fieldwork / field trips ☐ Farm work ☐
Heat ☐ Cold ☐ Electrical ☐ Mechanical ☐
Radiation ☐
Other:
………………………..….………..……………….
……………………………………………..............
Risk rating (using the Risk Matrix):
Risk controls
(tick boxes, provide details if necessary)
Gloves ☐ Type ………………………………
Safety glasses or goggles ☐
Heat-resistant gloves ☐
Fume hood ☐ Biosafety cabinet ☐
Training ☐.…………………………………….
………………………….…………..……………
Supervision ☐….……………………………..
…………………………………………………..
Vaccination
……………………….…………………………..
Other: ...………………………………………..
………….…………….………….………………
Workers initials:
Supervisors initials:
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PART A: continued
Agent, Task or Scenario 1:
Risk level (use risk matrix at end of Section A to complete)
SWP and RA Number and Name :
Nature of hazards
(tick boxes, provide details if necessary)
Toxic ☐
Flammable ☐ Corrosive ☐
Carcinogenic / mutagenic ☐
Restricted chemical ☐ PC1 ☐ PC2 ☐
PC2-GMO microbe ☐ PC2-GMO other ☐
Animals / animal samples ☐
Humans / human samples ☐
Fieldwork / field trips ☐ Farm work ☐
Heat ☐ Cold ☐ Electrical ☐ Mechanical ☐
Radiation ☐
Other:
………………………..….………..……………….
……………………………………………..............
Risk rating (using the Risk Matrix):
Risk controls
(tick boxes, provide details if necessary)
Gloves ☐ Type ………………………………
Safety glasses or goggles ☐
Heat-resistant gloves ☐
Fume hood ☐ Biosafety cabinet ☐
Training ☐.…………………………………….
………………………….…………..……………
Supervision ☐….……………………………..
…………………………………………………..
Vaccination
……………………….…………………………..
Other: ...………………………………………..
………….…………….………….………………
Workers initials:
Supervisors initials:
Agent, Task or Scenario 1:
Risk level (use risk matrix at end of Section A to complete)
SWP and RA Number and Name :
Nature of hazards
(tick boxes, provide details if necessary)
Toxic ☐
Flammable ☐ Corrosive ☐
Carcinogenic / mutagenic ☐
Restricted chemical ☐ PC1 ☐ PC2 ☐
PC2-GMO microbe ☐ PC2-GMO other ☐
Animals / animal samples ☐
Humans / human samples ☐
Fieldwork / field trips ☐ Farm work ☐
Heat ☐ Cold ☐ Electrical ☐ Mechanical ☐
Radiation ☐
Other:
………………………..….………..……………….
……………………………………………..............
Risk rating (using the Risk Matrix):
Risk controls
(tick boxes, provide details if necessary)
Gloves ☐ Type ………………………………
Safety glasses or goggles ☐
Heat-resistant gloves ☐
Fume hood ☐ Biosafety cabinet ☐
Training ☐.…………………………………….
………………………….…………..……………
Supervision ☐….……………………………..
…………………………………………………..
Vaccination
……………………….…………………………..
Other: ...………………………………………..
………….…………….………….………………
Workers initials:
Supervisors initials:
Add additional pages if required to capture all hazardous tasks and procedures.
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Risk Matrix:
PART B: Specific WHS training and/or additional Risk Assessment required
List other WHS training relevant to this position: Consult the training needs analysis
found at https://intranet.sydney.edu.au/science/soles/new-staff.html and
http://sydney.edu.au/whs/activities/training.shtml
□
□
□
□
□
Chemical Safety
Biosafety
Radiation Safety for Laboratory Workers
WHS for Supervisors and Managers
Responsible Research Practices (research
involving human/animal participants)
□
□
□
□
Manual Handling
Field Work / Field trips
□
PART C: Summary of risk to new worker:
Tick the appropriate box (indicate the highest level of risk of all agents or tasks listed above).
☐ The risk is insignificant and is unlikely to increase during the course of the project.
☐ The risk is significant but will be effectively controlled.
☐ There is uncertainty about the level of risk.
☐ The risk is significant and cannot be effectively controlled.
NOTE: Work must not commence if either “There is uncertainty about the level of risk” or
“The risk is significant and cannot be effectively controlled” has been selected.
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PART D: Declaration
Supervisor and worker signatures
By signing here, the supervisor and worker confirm that they have discussed the risks of the
project, that the worker has been given a chance to ask questions relating to the safety of the work
to be performed, that the worker has been provided with adequate resources and information to
perform their work safely, and that both partners agree on the summary of risk (appropriate box
checked above).
By signing here, the worker also acknowledges that they have read and understood all of the
relevant SWPs, Risk Assessments and SDS documents used to prepare this Hazard Assessment.
Supervisor …………………………….………………………...
Date ……………………….
Worker …………………………………………………………...
Date ……………………….
PART E: Working Safely After Hours
Everyone wanting and/or needing to work after hours, must read and adhere to the Working After
Hours Guidelines (http://sydney.edu.au/whs/guidelines/others/working_after_hours.shtml). Please
note, the normal operating hours of SOLES are Monday to Friday, 7am to 7pm - but this may differ
depending on building location and/or operational needs.
For students (Honours, HDR, etc.), it is also required that their supervisor sends an email to the
School’s Safety Officer ([email protected]) specifying the types of tasks and associated
risk levels (e.g. low, medium) that are to be performed after hours for the duration of their project
(approximate sates should be specified), and that the guidelines described in the Working After
Hours document are met (e.g. established RAs and SWPs, buddy system, etc.).
If any changes occur to what is specified in the email, the supervisor must notify the School’s
Safety Officer by email to provide an update before any new work can commence after hours.
By signing here, the worker and supervisor acknowledges and agree to the above conditions
relating to working safely after hours.
Supervisor …………………………….………………………...
Date …………………………….
Worker …………………………………………………………...
Date …………………………….
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