Hazardous substance risk assessment (NZ)

Use this form to assess one hazardous substance before work with it. Take 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 finish with a residual risk rating. Under the Health and Safety at Work (Hazardous Substances) Regulations 2017 a PCBU must keep an inventory of hazardous substances, hold the SDS, and control exposure below the workplace exposure standard.

CompanySiteDate

Hazardous substance risk assessment (NZ)

Company: ____________

Site: ____________

Date: ____________

Assessment details

	Product / substance name: ____________	N/A · Action
	Manufacturer / supplier: ____________	N/A · Action
	SDS on file: YES / NO SDS date: ____________	N/A · Action
	On the hazardous substance inventory: YES / NO	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 (workers, 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 sensitiser	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
	Oxidising	N/A · Action
	Corrosive to metals / gas under pressure	N/A · Action
	Other (specify): ____________	N/A · Action

Form and route of exposure

	Physical form (tick): gas / vapour / mist / fume / dust / fibre / liquid / solid or powder / aerosol	N/A · Action
	Route of exposure (tick): inhalation / skin absorption / eye contact / ingestion	N/A · Action
	Workplace exposure standard (WES, from the SDS or the WorkSafe NZ list): ____________	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 substance?	N/A · Action
	Substitution: is a less hazardous product available?	N/A · Action
	Isolation and 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 health monitoring 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 substance): ____________	N/A · Action
	Body/feet (apron, overalls, 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
	Certified handler or approved handler in place where the substance requires one	N/A · Action

Storage and disposal

	How the product is stored (ventilation, segregation from incompatibles, secured): ____________	N/A · Action
	Container labelled correctly (product identifier + GHS pictograms)	N/A · Action
	Required signage in place for the quantities held	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: ____________________

swmspack.com · Free printable checklist. Not legal advice; adapt to your site.

Common questions

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

From the substance's safety data sheet (SDS). The supplier must provide one. The hazards, the workplace exposure standard, and the first aid measures all come from the SDS, which you must hold along with an inventory of hazardous substances under the 2017 Regulations.

▸What does the law require for hazardous substances in NZ?

Under the Health and Safety at Work (Hazardous Substances) Regulations 2017 a PCBU must keep an inventory, hold current SDS, provide signage and containment for the quantities held, control exposure below the workplace exposure standard, and have certified or approved handlers where required. WorkSafe New Zealand enforces this; the EPA classifies substances.

▸What is the hierarchy of controls?

Elimination, substitution, isolation, engineering controls, administrative controls, then PPE last. The earlier steps remove or reduce the hazard for everyone; PPE only protects the one worker wearing it, so it is the last line, not the first.

Working with hazardous substances needs controls set out for the job. A site-specific SSSP does that; generate yours in minutes.

Forms record the day; the SSSP is the plan the main contractor asks for before you start. Generate a site-specific one for your trade, checked against HSWA 2015.

See a sample SSSP Build my SSSP, NZ$89

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