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Risk Assessment Tool

Principle Investigator/Area Supervisor:

(Use this tool to analyze potential risks in your work area.)


Brief Description of Laboratory Activities/Project:

Date of Assessment:

Department:
Assessor(s)/Team:
Building:

Positions affected by area (lab personnel/students/faculty/staff/visitors):

Room Number:

Lab Operation Hours (if operational hours impact the Risk Assessment):

Hazard/Exposure Category

How could you be


exposed to this hazard?
(briefly describe)

Given the exposure, what is


negative outcome? (briefly
describe)

Consequences (Outcome)
What is the
expected harm?

Value
0 to 5

Existing Control
Measure In Place

Probability
Risk
Value 0 to Rating
5
Number

Chemical Exposure - Toxic /


Highly Toxic
0
Chemical Exposure - Corrosive
0
Chemical Exposure - Reproductive
Toxins (Mutagen/Teratogens)
0
Exposure to
Carcinogens
0
Exposure to Irritants
0
Exposure to Sensitizers
0
Exposure to Nonionizing Radiation
0
Exposure to Ionizing Radiation
0

How could you be


exposed to this hazard?
(briefly describe)

Hazard/Exposure Category

Given the exposure, what is


negative outcome? (briefly
describe)

Consequences (Outcome)
What is the
expected harm?

Value
0 to 5

Existing Control
Measure In Place

Probability
Risk
Value 0 to Rating
5
Number

Exposure to Organic Peroxide


0
Storage or Use of Explosives
0
Water Reactive Material
0
Unstable (reactive) /
Polymerizable Material
0
Combustible Liquid
Flammables

/
0

Exposure to
Biohazards/Bloodborne Pathogens
0
Combustible Dust
0
Oxidizer
0
Pyrophoric Material
0
Exposure to Compressed
Gases
cryogenic

(including
material)

Exposure to heat/cold
0

How could you be


exposed to this hazard?
(briefly describe)

Hazard/Exposure Category

Given the exposure, what is


negative outcome? (briefly
describe)

Consequences (Outcome)
What is the
expected harm?

Value
0 to 5

Existing Control
Measure In Place

Probability
Risk
Value 0 to Rating
5
Number

Exposure to Noise
0
Walking/Working Surfaces
0
Means of Egress (Emergency)
0
Energy Control (Lock-out/Tag-out)
0
Exposure to Fall Hazards
0
Pressure vessels
0
Material Handling of
Chemicals (Bulk)

Physical Hazards - Exposure


Sharp Objects

0
to
0

Physical Hazards Exposure to Rotating


Equipment & Points of
Operation

Welding/Cutting Hazards
0
Exposure to Electrical Hazards
0
Employee knowledge of the chemical hygiene plan

Hazard/Exposure Category

How could you be


exposed to this hazard?
(briefly describe)

Given the exposure, what is


negative outcome? (briefly
describe)

Consequences (Outcome)
What is the
expected harm?

Value
0 to 5

Existing Control
Measure In Place

Probability
Risk
Value 0 to Rating
5
Number

Eye Hazards
0
Unattended Operations

Working Alone
0
Working with Animals or Biological Agents
0

Risk Hazard Matrix


Consequences

Probability

Unlikely
People

1
Fatality(s) / Chronic Illness with no recovery

Injury/Illness requiring personnel to be hospitalized/off


work for extended period of time

Probably
Possible will occur
to occur under
over time routine
conditions

Will occur
under
current
conditions

Frequent/
Regular /
Continuous
Occurrence

High Risk
Injury/Illness requiring medical treatment by a medical
professional beyond first aid / no time off work required

Injury/Illness requiring first aid treatment by nonmedical personnel

Medium Risk

Low Risk
Minimal - no medical treatment or assistance
needed.