Chemical (HazCom) risk assessment form

Use this form to assess one hazardous chemical or product before work with it. Pull the hazard information from its safety data sheet (SDS), record who is exposed and how, list the controls in the hierarchy order (elimination and substitution first, PPE last), and conclude with a residual risk rating. It supports your Hazard Communication program under OSHA 29 CFR 1910.1200.

CompanyJobsiteDate

Chemical (HazCom) risk assessment form

Company: ____________

Jobsite: ____________

Date: ____________

Assessment details

	Product / substance name: ____________	N/A · Action
	Manufacturer / supplier: ____________	N/A · Action
	SDS on file and dated: YES / NO SDS date: ____________	N/A · Action
	Task or process it is used in: ____________	N/A · Action
	Assessed by: ____________ Date: ____________	N/A · Action

Who is exposed, and how much

	People at risk (employees, other trades, visitors): ____________	N/A · Action
	How much is used and how often: ____________	N/A · Action
	How long is each exposure: ____________	N/A · Action
	Location / area where it is used: ____________	N/A · Action

Hazard classification (from the SDS, tick all that apply)

	Acute toxicity (fatal / toxic / harmful)	N/A · Action
	Skin corrosion or irritation	N/A · Action
	Serious eye damage or irritation	N/A · Action
	Respiratory or skin sensitizer	N/A · Action
	Carcinogen, mutagen, or reproductive toxicant	N/A · Action
	Specific target organ toxicity (single or repeated exposure)	N/A · Action
	Aspiration hazard	N/A · Action
	Flammable	N/A · Action
	Oxidizer	N/A · Action
	Corrosive to metals / gases under pressure	N/A · Action
	Other (specify): ____________	N/A · Action

Form and route of exposure

	Physical form (tick): gas / vapor / mist / fume / dust / fiber / liquid / solid or powder / aerosol	N/A · Action
	Route of exposure (tick): inhalation / skin absorption / eye contact / ingestion	N/A · Action
	Permissible Exposure Limit (PEL) or other exposure limit from the SDS: ____________	N/A · Action

Health risks

List the health effects from the SDS (acute and chronic): ____________

N/A · Action

Controls (in the hierarchy order)

	Elimination: can the task be done without this chemical?	N/A · Action
	Substitution: is a less hazardous product available?	N/A · Action
	Engineering: local exhaust ventilation, enclosure, wetting down	N/A · Action
	Administrative: limiting time, restricting access, training, safe work procedure	N/A · Action
	PPE (last line, not the first): specify below	N/A · Action
	Is medical surveillance or exposure monitoring indicated for this substance?	N/A · Action

PPE (identify type and specification)

	Respiratory (respirator type / cartridge, or dust mask): ____________	N/A · Action
	Eyes/face (safety glasses / goggles / face shield): ____________	N/A · Action
	Gloves (specify material for this chemical): ____________	N/A · Action
	Body/feet (apron, coveralls, footwear): ____________	N/A · Action
	Workers trained on the PPE selected and its limits	N/A · Action

First aid and emergency

	First aid measures from the SDS (eyes, skin, inhalation, ingestion): ____________	N/A · Action
	Eyewash / emergency shower available and accessible where needed	N/A · Action
	Spill response and fire measures from the SDS understood	N/A · Action

Storage and disposal

	How the product is stored (ventilation, segregation from incompatibles, secured): ____________	N/A · Action
	Container labeling correct (product identifier + hazard pictograms)	N/A · Action
	Disposal method for waste and empty containers: ____________	N/A · Action

Residual risk rating (after controls)

	With the controls above in place, residual risk is: LOW / MEDIUM / HIGH	N/A · Action
	If MEDIUM or HIGH: additional controls required before work proceeds: ____________	N/A · Action
	Review date or trigger (new SDS, new task, incident): ____________	N/A · Action

Completed by: ____________________

Signature: ____________________

tailgatedocs.com · Free printable form. Not legal advice; adapt to your jobsite.

Common questions

▸Where do I get the hazard information for this form?

From the product's safety data sheet (SDS). Under OSHA's Hazard Communication Standard the manufacturer must supply a 16-section SDS, and you must keep it accessible. Sections 2 (hazards), 8 (exposure controls and PEL), and 4 (first aid) feed most of this form.

▸Is a written chemical risk assessment required by OSHA?

OSHA's Hazard Communication Standard requires a written hazard communication program, labels, SDS access, and worker training. A per-chemical risk assessment like this is the practical way to show you evaluated the hazards and chose controls, and it is what GCs and insurers expect to see.

▸What is the hierarchy of controls?

Elimination, substitution, engineering controls, administrative controls, then PPE last. PPE protects one worker if it fits and is worn correctly; the earlier steps remove or reduce the hazard for everyone, so they come first.

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