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Risk Assessment Tool
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Principle Investigator/Area Supervisor: 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):
Consequences (Outcome)
0
Chemical Exposure - Corrosive
0
0
0
Exposure to Irritants0
Exposure to Sensitizers0
Exposure to Nonionizing Radiation
0
Exposure to Ionizing Radiation
0
Risk Assessment Tool (Use this tool to analyze potential risks in your work area.)
Hazard/Exposure Category How could you be
exposed to this hazard? (briefly describe)
Given the exposure, what is negative outcome? (briefly
describe)
Existing Control Measure In Place
Probability Value 0
to 5
Risk Rating
NumberWhat is the
expected harm?Value
0 to 5
Chemical Exposure - Toxic / Highly Toxic
Chemical Exposure - Reproductive Toxins (Mutagen/Teratogens)
Exposure to Carcinogens
Consequences (Outcome)
Hazard/Exposure Category How could you be
exposed to this hazard? (briefly describe)
Given the exposure, what is negative outcome? (briefly
describe)
Existing Control Measure In Place
Probability Value 0
to 5
Risk Rating
NumberWhat is the
expected harm?Value
0 to 5
Exposure to Organic Peroxide
0
Storage or Use of Explosives
0
Water Reactive Material
0
0
0
0
Combustible Dust
0
Oxidizer
0
Pyrophoric Material
0
0
Exposure to heat/cold
0
Unstable (reactive) / Polymerizable Material
Combustible Liquid / Flammables
Exposure to Biohazards/Bloodborne Pathogens
Exposure to Compressed Gases (including cryogenic material)
Consequences (Outcome)
Hazard/Exposure Category How could you be
exposed to this hazard? (briefly describe)
Given the exposure, what is negative outcome? (briefly
describe)
Existing Control Measure In Place
Probability Value 0
to 5
Risk Rating
NumberWhat is the
expected harm?Value
0 to 5
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
0
0
0
Welding/Cutting Hazards
0
Exposure to Electrical Hazards
0
Employee knowledge of the chemical hygiene plan0
Material Handling of Chemicals (Bulk)
Physical Hazards - Exposure to Sharp Objects
Physical Hazards - Exposure to Rotating Equipment & Points of Operation
Consequences (Outcome)
Hazard/Exposure Category How could you be
exposed to this hazard? (briefly describe)
Given the exposure, what is negative outcome? (briefly
describe)
Existing Control Measure In Place
Probability Value 0
to 5
Risk Rating
NumberWhat is the
expected harm?Value
0 to 5
Eye Hazards0
Unattended Operations0
Working Alone
0
Working with Animals or Biological Agents
0
Risk Hazard Matrix
Consequences Probability
People
Unlikely
Fatality(s) / Chronic Illness with no recovery 5
1 2 3 4 5
4
3
2
1
Possible to occur over time
Probably will occur under routine conditions
Will occur under current conditions
Frequent/ Regular / Continuous Occurrence
Injury/Illness requiring personnel to be hospitalized/off work for extended period of time
Injury/Illness requiring medical treatment by a medical professional beyond first aid / no time off work required
Injury/Illness requiring first aid treatment by non-medical personnel
Minimal - no medical treatment or assistance needed.
Medium Risk
Low Risk
High Risk
