CHEMICAL RISK ASSESSMENT TEMPLATE

Company: [COMPANY NAME]
Assessment Area: [AREA/PROCESS]
Assessment Date: [DATE]
Assessed by: [NAME & POSITION]
Review Date: [DATE]
Assessment Reference: [REF NUMBER]

CHEMICAL INFORMATION:

Chemical Name: [CHEMICAL NAME]
Trade Name: [TRADE/BRAND NAME]
CAS Number: [CAS NUMBER]
Supplier: [SUPPLIER NAME]
SDS Date: [SDS DATE]
Physical Form: □ Solid □ Liquid □ Gas □ Vapor □ Aerosol
Quantity Used: [AMOUNT] per [TIME PERIOD]
Storage Quantity: [AMOUNT]

HAZARD CLASSIFICATION:

GHS HAZARD CLASSES:
□ Explosives
□ Flammable gases
□ Flammable liquids
□ Flammable solids
□ Oxidizing substances
□ Organic peroxides
□ Toxic substances
□ Corrosive substances
□ Irritant substances
□ Sensitizing substances
□ Carcinogenic substances
□ Mutagenic substances
□ Reproductive toxins
□ Environmental hazards

HEALTH HAZARDS:
□ Acute toxicity (oral, dermal, inhalation)
□ Skin corrosion/irritation
□ Eye damage/irritation
□ Respiratory sensitization
□ Skin sensitization
□ Germ cell mutagenicity
□ Carcinogenicity
□ Reproductive toxicity
□ Target organ toxicity (single exposure)
□ Target organ toxicity (repeated exposure)
□ Aspiration hazard

PHYSICAL HAZARDS:
□ Explosive
□ Flammable
□ Oxidizing
□ Corrosive to metals
□ Gas under pressure
□ Self-heating
□ Pyrophoric
□ Self-reactive
□ Organic peroxide

EXPOSURE ASSESSMENT:

ROUTES OF EXPOSURE:
□ Inhalation
□ Skin contact
□ Eye contact
□ Ingestion
□ Injection

EXPOSURE SCENARIOS:
Scenario 1: [NORMAL OPERATIONS]
Description: [DETAILED DESCRIPTION OF NORMAL USE]
Duration: [TIME PERIOD]
Frequency: [HOW OFTEN]
Concentration/Amount: [ESTIMATED EXPOSURE LEVEL]
Workers Exposed: [NUMBER AND TYPES]

Scenario 2: [MAINTENANCE/CLEANING]
Description: [DETAILED DESCRIPTION]
Duration: [TIME PERIOD]
Frequency: [HOW OFTEN]
Concentration/Amount: [ESTIMATED EXPOSURE LEVEL]
Workers Exposed: [NUMBER AND TYPES]

Scenario 3: [EMERGENCY/SPILL RESPONSE]
Description: [DETAILED DESCRIPTION]
Duration: [TIME PERIOD]
Frequency: [HOW OFTEN]
Concentration/Amount: [ESTIMATED EXPOSURE LEVEL]
Workers Exposed: [NUMBER AND TYPES]

EXPOSURE LIMITS:
OSHA PEL: [VALUE] [UNITS]
ACGIH TLV: [VALUE] [UNITS]
NIOSH REL: [VALUE] [UNITS]
Company Limit: [VALUE] [UNITS]
STEL (15-min): [VALUE] [UNITS]
Ceiling Limit: [VALUE] [UNITS]

RISK CHARACTERIZATION:

INHALATION RISK:
Exposure Level: [MEASURED/ESTIMATED]
Exposure Limit: [APPLICABLE LIMIT]
Risk Ratio: [EXPOSURE/LIMIT]
Risk Level: □ Low □ Medium □ High
Comments: [ASSESSMENT NOTES]

SKIN CONTACT RISK:
Potential for Contact: □ Minimal □ Occasional □ Frequent
Skin Absorption: □ Yes □ No □ Unknown
Protective Measures: [CURRENT CONTROLS]
Risk Level: □ Low □ Medium □ High
Comments: [ASSESSMENT NOTES]

EYE CONTACT RISK:
Potential for Contact: □ Minimal □ Occasional □ Frequent
Severity of Effects: □ Mild irritation □ Serious damage
Protective Measures: [CURRENT CONTROLS]
Risk Level: □ Low □ Medium □ High
Comments: [ASSESSMENT NOTES]

CONTROL MEASURES:

HIERARCHY OF CONTROLS:

1. ELIMINATION:
□ Substitute with safer alternative
□ Eliminate process requiring chemical
Current Status: [IMPLEMENTED/NOT FEASIBLE/UNDER CONSIDERATION]
Comments: [DETAILS]

2. SUBSTITUTION:
□ Less hazardous chemical
□ Different physical form
□ Lower concentration
Alternative Options: [LIST ALTERNATIVES CONSIDERED]
Current Status: [IMPLEMENTED/NOT FEASIBLE/UNDER CONSIDERATION]
Comments: [DETAILS]

3. ENGINEERING CONTROLS:
□ Local exhaust ventilation
□ General ventilation
□ Enclosed processes
□ Automation/remote operation
□ Isolation/containment
Current Controls: [DESCRIBE EXISTING CONTROLS]
Effectiveness: □ Adequate □ Needs improvement □ Inadequate
Additional Controls Needed: [SPECIFY]

4. ADMINISTRATIVE CONTROLS:
□ Work procedures/SOPs
□ Training programs
□ Job rotation
□ Access restrictions
□ Warning signs/labels
□ Exposure monitoring
Current Controls: [DESCRIBE EXISTING CONTROLS]
Effectiveness: □ Adequate □ Needs improvement □ Inadequate
Additional Controls Needed: [SPECIFY]

5. PERSONAL PROTECTIVE EQUIPMENT:
□ Respiratory protection
□ Chemical-resistant gloves
□ Chemical-resistant clothing
□ Eye/face protection
□ Emergency equipment
Current PPE: [DESCRIBE CURRENT PPE]
Effectiveness: □ Adequate □ Needs improvement □ Inadequate
Additional PPE Needed: [SPECIFY]

STORAGE AND HANDLING:

STORAGE REQUIREMENTS:
□ Segregation from incompatibles
□ Temperature control
□ Ventilation requirements
□ Secondary containment
□ Fire protection
□ Security measures
Current Storage: [DESCRIBE CURRENT STORAGE]
Deficiencies: [LIST ANY DEFICIENCIES]

HANDLING PROCEDURES:
□ Written procedures available
□ Training provided
□ Supervision adequate
□ Equipment appropriate
□ Emergency procedures
Current Procedures: [DESCRIBE CURRENT PROCEDURES]
Improvements Needed: [LIST IMPROVEMENTS]

INCOMPATIBLE MATERIALS:
[LIST CHEMICALS THAT MUST BE KEPT SEPARATE]

EMERGENCY PROCEDURES:

SPILL RESPONSE:
Small Spills: [PROCEDURE]
Large Spills: [PROCEDURE]
Equipment Required: [LIST EQUIPMENT]
Personnel Training: [TRAINING STATUS]

EXPOSURE RESPONSE:
Inhalation: [FIRST AID PROCEDURE]
Skin Contact: [FIRST AID PROCEDURE]
Eye Contact: [FIRST AID PROCEDURE]
Ingestion: [FIRST AID PROCEDURE]

FIRE/EXPLOSION RESPONSE:
Extinguishing Media: [APPROPRIATE EXTINGUISHERS]
Special Hazards: [COMBUSTION PRODUCTS, ETC.]
Fire Fighting Procedures: [SPECIAL PROCEDURES]

WASTE DISPOSAL:
Disposal Method: [APPROVED DISPOSAL METHOD]
Waste Classification: [HAZARDOUS/NON-HAZARDOUS]
Disposal Contractor: [CONTRACTOR NAME]
Documentation: [MANIFESTS, CERTIFICATES]

MONITORING REQUIREMENTS:

EXPOSURE MONITORING:
Monitoring Required: □ Yes □ No
Frequency: [SCHEDULE]
Method: [SAMPLING/ANALYTICAL METHOD]
Personnel Monitored: [WHO GETS MONITORED]
Action Levels: [LEVELS REQUIRING ACTION]

HEALTH SURVEILLANCE:
Medical Surveillance Required: □ Yes □ No
Type of Surveillance: [MEDICAL EXAMS, TESTS]
Frequency: [SCHEDULE]
Medical Provider: [PROVIDER NAME]
Records Maintenance: [RECORD KEEPING REQUIREMENTS]

ENVIRONMENTAL MONITORING:
Air Monitoring: □ Required □ Not Required
Water Monitoring: □ Required □ Not Required
Soil Monitoring: □ Required □ Not Required
Waste Monitoring: □ Required □ Not Required

TRAINING REQUIREMENTS:

GENERAL CHEMICAL SAFETY:
□ Hazard communication training
□ SDS interpretation
□ Labeling systems
□ Emergency procedures
□ PPE selection and use

SPECIFIC CHEMICAL TRAINING:
□ Chemical-specific hazards
□ Safe handling procedures
□ Exposure controls
□ Emergency response
□ Waste disposal

SPECIALIZED TRAINING:
□ Respiratory protection
□ Confined space entry
□ Hazardous waste operations
□ Emergency response
□ Medical surveillance

TRAINING RECORDS:
Training Provider: [PROVIDER]
Last Training Date: [DATE]
Next Training Due: [DATE]
Training Documentation: [LOCATION OF RECORDS]

REGULATORY COMPLIANCE:

APPLICABLE REGULATIONS:
□ OSHA Hazard Communication Standard
□ OSHA Respiratory Protection Standard
□ OSHA PPE Standards
□ EPA TSCA Requirements
□ DOT Shipping Regulations
□ Local Environmental Regulations

REQUIRED DOCUMENTATION:
□ Safety Data Sheets current and accessible
□ Chemical inventory maintained
□ Training records current
□ Exposure monitoring records
□ Medical surveillance records
□ Waste disposal documentation

PERMITS/REGISTRATIONS:
□ Air emissions permits
□ Waste disposal permits
□ Storage permits
□ Transportation permits

RISK EVALUATION:

OVERALL RISK ASSESSMENT:
Inhalation Risk: □ Low □ Medium □ High
Skin Contact Risk: □ Low □ Medium □ High
Eye Contact Risk: □ Low □ Medium □ High
Fire/Explosion Risk: □ Low □ Medium □ High
Environmental Risk: □ Low □ Medium □ High

OVERALL RISK LEVEL: □ Low □ Medium □ High

RISK ACCEPTABILITY:
□ Risk acceptable with current controls
□ Risk acceptable with additional controls
□ Risk unacceptable - immediate action required

ACTION PLAN:

IMMEDIATE ACTIONS (24 hours):
1. [ACTION ITEM]
   Responsible: [NAME]
   Due Date: [DATE]

2. [ACTION ITEM]
   Responsible: [NAME]
   Due Date: [DATE]

SHORT-TERM ACTIONS (30 days):
1. [ACTION ITEM]
   Responsible: [NAME]
   Due Date: [DATE]

2. [ACTION ITEM]
   Responsible: [NAME]
   Due Date: [DATE]

LONG-TERM ACTIONS (90 days):
1. [ACTION ITEM]
   Responsible: [NAME]
   Due Date: [DATE]

2. [ACTION ITEM]
   Responsible: [NAME]
   Due Date: [DATE]

REVIEW AND UPDATE:

REVIEW TRIGGERS:
□ Annual review
□ Change in process
□ New exposure data
□ Incident occurrence
□ Regulatory changes
□ SDS updates

NEXT REVIEW DATE: [DATE]

APPROVAL:

Chemical Risk Assessment Completed by:
Name: _________________ Position: _________________
Signature: _________________ Date: _________________

Reviewed by Industrial Hygienist:
Name: _________________ Position: _________________
Signature: _________________ Date: _________________

Approved by Safety Manager:
Name: _________________ Position: _________________
Signature: _________________ Date: _________________

Document Control:
Version: 1.0
Document ID: CRA-[CHEMICAL]-001
Next Review: [DATE]
Distribution: [LIST RECIPIENTS]