EXPERIMENT REQUEST & RISK ASSESSMENT SHEET

TEACHER CODE:

DAY & DATE REQUIRED:

Day:
Date:
/

CLASS / SUBJECT:

LESSON/TIME
/

ROOM:

NO. OF GROUPS:

Scientific Assistant
Required

TITLE / DESCRIPTION OF PRAC:

YES/NO
EXPERIMENT RISK ASSESSMENT (Select the relevant aspects)
LOW RISK

MEDIUM RISK

NO heat, pressure or vacuums, mains

voltage, corrosive, volatile, flammable or toxic
chemicals, handling of dangerous biological
materials or chemicals.

Completion of page two and sign.

HIGH RISK

Involves: 1.

Involves: 1.

2.

2.

3.

3.

Complete page two and give to the

Supervisor for signing

Complete page two and obtain

Supervisor signature.

SPECIFIC RISK CONTROL MEASURES TO BE APPLIED (in addition to normal laboratory safety procedures).
Refer to Chemwatch or MSDS.
Remember: Safety Glasses to be used at all times when heating and for use of toxics/corrosives. No sitting at /on stools / benches while performing an
experiment. Protective clothing is to be used for anything wet. Hair tied back for pracs, and covered shoes to be worn in laboratory. Remember to consider the
hazardous substances that may be produced.

EQUIPMENT / CHEMICAL LIST

APPARATUS / EQUIPMENT

QTY

CHEMICALS / BIOLOGICALS

QTY

DISPOSAL
CODE

DISPOSAL METHODS refer to statements in Chemwatch / MSDSs to determine necessary procedures.

A. flush with running water down
the sink.
E. collect for reuse (eg. non-reacted
metal strips)

B. class room rubbish (nonhazardous solids)

F. package for refrigeration and later
disposal (eg. animal dissection
waste)

C. outside rubbish bins (eg. food and

other messy solids)
G. collect in labelled waste containers
for appropriate hazardous waste
disposal (eg. lead & silver compounds,
immiscible organics, etc)

D. broken glass bin

RISK MINIMISATION STRATEGIES for Medium and High risk experiments.

Preparation
Class size is appropriate
Class has appropriate experience
Class groups are appropriately spaced

Emergency procedures have been

considered

Prior demonstration of skills is

necessary

Teacher has relevant previous

experience

Appropriate spillage control

methods are on hand

Hazards have been assessed

Number of groups is desirable

Organisation
Room is appropriate for the experiment

Movement of people has been

considered

All materials to be used have been

considered

Use of lab coat/apron necessary

Synthetics/parkers removed

Safety glasses /Goggles necessary

Presence of Scientific Assistant

Advantageous

Safe supervision and Personal Protection

Prior safety explanations are
necessary
Hair tied back
Need for students wearing contact
lenses to wear goggles

Jewellery removed as appropriate

Contact lenses removed

Complete, covered footwear

Experimental practices
Appropriate practices for minimum skin
contact

Amounts of chemicals are appropriate

Need for good ventilation

Need to Inform students of hazards

involved

Need for use of fume cupboard

Students have been reminded about:

Lighting and use of Bunsen Burners

Heating of liquids

Carrying glass wear

Heating in test tubes

Handling hot apparatus/liquids

Handling reagent bottles

CALCULATION OF THE RISK High Risk Only

(Save form as a document of your own, then reopen and move lines to required position.)

The risk is calculated after considering the Risk Minimisation strategies above.
RISK SCORE

TIE LINE

PROBABILITY

POSSIBLE
CONSEQUENCES

ALMOST
CERTAIN

EXPOSURE
QUITE
POSSIBLE

VERY RARE
RARE

UNUSUAL
BUT
POSSIBLE

INFREQUENT

CATASTROPHE

MULTIPLE
FATALITIES

DISASTER

FATALITY

400

SERIOUS
INJURY

HIGH RISK
200

VERY SERIOUS
SERIOUS

FREQUENT
CONTINUOUS

CONCEIVABLE
BUT VERY
UNLIKELY

VERY
HIGH RISK

300

100
OCCASIONAL

REMOTELY
POSSIBLE

NUMEROUS
FATALITIES

500

80
60

CASUALTY
TREATMENT

IMPORTANT

FIRST AID
TREATMENT

NOTICEABLE

SUBSTANTIAL
RISK

MODERATE
RISK

40

20

PRACTICALLY
IMPOSSIBLE

10

RISK
PERHAPS
ACCEPTABLE

SIGNATURES:
RISK

TEACHER/LECTURER

DATE

senior/supervisor

DATE
--/ --/--