Carcinogenicity Risk Assessment Form
Please provide the following details to evaluate the potential carcinogenicity risk of a substance, mixture, product, or process.
Name of Substance, Mixture, Product, or Process
*
Intended Use or Application
*
Physical State
*
Please Select
Solid
Liquid
Gas
Other
Known Components or Ingredients
*
Potential Routes of Exposure
*
Inhalation
Dermal (skin contact)
Oral (ingestion)
Injection
Other
Existing Hazard Classification (if any)
Please Select
Not Classified
IARC Group 1 (Carcinogenic to humans)
IARC Group 2A (Probably carcinogenic)
IARC Group 2B (Possibly carcinogenic)
IARC Group 3 (Not classifiable)
IARC Group 4 (Probably not carcinogenic)
Other/Specify
Estimated Amount or Frequency of Use
Existing Control Measures or Precautions
Summary of Previous Risk Assessments (if available)
Name and Role of Person Completing This Assessment
*
Submit Assessment
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