This form is used in the assessment of substances considered potentially risky or hazardous to human beings. The format of this form is simple and easy to fill out. This assessment is usually carried out by an assessor. The form comes in handy especially in matters to do with insurance.
Name of site concerned: ____________________________________________________
Description of work carried out at the site: _____________________________________
Description of substances used at the site:
Name of substance Name of manufacturer: Date of manufacture
____________________ __________________________ __________________
____________________ __________________________ __________________
____________________ __________________________ __________________
____________________ __________________________ __________________
____________________ __________________________ __________________
Describe risk posed by each substance:
Name of substance Possible risk Persons at risk
__________________________ ____________________ __________________
__________________________ ____________________ __________________
__________________________ ____________________ __________________
__________________________ ____________________ __________________
__________________________ ____________________ __________________
Give details about how the risk can be minimized:
Name of substance Action to minimize risk
________________________________ ____________________________________
________________________________ ____________________________________
________________________________ ____________________________________
________________________________ ____________________________________
________________________________ ____________________________________
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