Substance Name:	Date of Assessment:
How is the substance used?
Recognised Hazards: or X	Harmful to the environment?	Corrosive	Harmful/Irritant	Health Hazard
Highly Flammable	Oxidising	Compressed Gas	Acute Toxicity
Other:

Routes of Exposure: or X	Eye injury	Inhalation	Skin puncture
Ingestion	Skin contact	Skin absorption

Personal Protective Equipment (PPE) or X	Safety Glasses	Protective Gloves	Coveralls	Rubber boots
Goggles	Face Shield	Protective Mask	Respiratory Equipment (RPE)
Other

Fire extinguisher media. or X	Dry Powder	Foam	Co2	Water

First Aid Measures or X Other	Emergency eye wash	Irrigate with water	Provide fresh air	Wash with soap & water	Seek medical advice.

Operational Controls or X	Control amounts used	Good housekeeping	Handle container with care	Launder contaminated clothing
Natural ventilation provided	No eating or drinking while in use	No smoking while in use	Pesticide application records kept
Training provided	Washing facilities provided	Authorised users only	Warning signs displayed
Other:

Storage, disposal & spillage controls: or X	Containers suitably labelled	Correct disposal of contaminated material	Correct storage facilities	Do not empty into drains.
Keep away from ignition sources.	Keep in a cool place.	No smoking	Prevent spillages
Secure pesticides storage	Spillages cleared up immediately	Spillages soaked up with sand.	Store away from heat
Suitable spill containment provided	Use spill response kit.	Warning signs displayed.
Other:

Assessor:	Signed: