Chemical Risk Assessment Checklist Form
Use this form to assess chemical hazards, current controls, exposure risks, and required follow-up actions for a site or process.
Assessment Details
Assessor Name
*
Role / Title
*
Assessment Date
*
-
Month
-
Day
Year
Date
Site / Location or Department
*
Chemical Information
Chemical/Product Name
*
Chemical Type or Category
*
Cleaning Agent
Solvent
Corrosive
Flammable
Toxic
Other
Intended Use / Process
*
Risk Checklist and Rating
Storage/Labeling Condition
*
Compliant and clearly labeled
Minor issues
Needs improvement
Non-compliant
Exposure Routes Present
Inhalation
Skin contact
Eye contact
Ingestion
Other
PPE Availability and Emergency Preparedness
*
Rows
Available
In Use
Appropriate PPE
1
2
Spill kit available
3
4
Emergency eyewash/shower available
5
6
Spill/emergency procedure known
7
8
Overall Risk Level
*
Low
1
2
3
4
High
5
1 is Low, 5 is High
Submit
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