CMH-RA_Part_Substance

Company Name

Hazardous Substances Risk Assessment - Core Details

Employee

Designation

Location

Department / Section

Date of Assessment

Time of Review

Task Being Assessed

The Substance or Product Produced

Trade Name

Reference No

Safety Data Sheet

Supplier Name

Emergency Telephone Number

Suppliers Address

Telephone Number

Email

Web Address

Hazard Classification

Select Hazard Symbol(s)

Check if Exposure Limites No Applicable

Check

Substance

Exposure Limit

Long Term

Short Term

Physical Properties

Other (specify)

Brief Details of Health Effects

To be filled in by Assessor / Manager / Supervisor:

Assessor / Manager / Supervisor

Reference No

Signed

________________________________

Date

Display sign-off

Email

Confirm