Chemical Hazard Assessment Worksheet

Chemical Hazard Assessment Worksheet
Form Instructions For Step 1 Name of Chemical:
1. Provide the answer in the text box "Used For What Task"
2. Using the MSDS or the SDS insert the "Name of Chemical"
3. List the positions that are affected or could potentially be affected by the chemical seperate the positions with a comma
4. Using you Material Safety Data Sheet (MSDS) or the Safety Data Sheet (SDS) Add ALL the ingredients listed in the data sheet along with CAS No. Concentration% and the exposure limits.
5. After you have listed the ingredients click on the yellow box to expand the Alberta Schedule 1 list and determine if any of the ingredients you listed are in the table. NOTE: If you find a chemical on the list that you have in your ingredients then you MUST develop a Code of Practice for that product.
1. Used For What Task
2. Name of Chemical
3. What Position's are Affected - Make a list seperated by a comma
4. List the Ingredients*
5. Create Assessment for each hazard*
HealthSafetyHealth & Safety
7. List Control Measure for each Hazard Listed*
- Schedule 1 from Alberta OH&S Code
  - Arsenic and arsenic compounds
  - Asbestos
  - Benzene
  - Beryllium
  - 1,3‐Butadiene
  - Cadmium
  - Coal tar pitch volatiles
  - 1,2‐Dibromoethane (Ethylene dibromide)
  - Ethylene oxide
  - Hexachlorobutadiene
  - Hydrazines
  - Hydrogen sulphide
  - Isocyanates
  - Lead and lead compounds
  - Methyl bromide
  - Methyl hydrazine
  - Perchlorates
  - Silica‐crystalline, respirable
  - Styrene in styrene resin fabrication
  - Vinyl chloride (Chloroethylene)
  - Zinc chromate
- Should be Empty: