Location of the process or work where the chemical is used
Indicate which route(s) of exposure the substance takes:
Name the risks to health from exposure to the substance:
People at Risk
Containment and Disposal
Containment measure and disposal method
Prevention of Hazards
Prevention of hazards:
Attach photos of identified hazards and annotations:
Is the exposure sufficiently controlled?
Risk rating after following control measures:
Name and Signature of the Inspector:
Please note that this checklist template is a hypothetical example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
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