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HAZARD ASSOCIATED WITH THE ACTIVITIES (*L = LIKELIHOOD; C = CONSEQUENCE. REFER TO RISK MATRIX ON PAGE 3)
RISK CONTROLS
☐ ☒ ☐ ☐
☐ ☒ ☐ ☐
Supervisor approval and Delay proposed work
Supervisor approval Supervisor approval
Floor Safety Officer approval Refer to Safety Committee
APPROVAL TO WORK
User declaration
I understand the hazards associated with this activity and agree to implement the proposed risk controls. The proposed work [does / does not]
involve the use of a prohibited or restricted carcinogen or other internally restricted chemical (See Section 4.4-5 of School Safety Handbook); if
I am using such a chemical, I have completed an additional more detailed University Risk Assessment for handling a scheduled carcinogen.
Risk Matrix
Consequence
C1 C2 C3 C4 C5
L5
Is expected to
occur in most Medium High High Very High Very High
Almost Certain
circumstances
L4
Will probably
happen in most Medium Medium High High Very High
hLikelihood
Likely
circumstances
L3
Could occur at
some time Low Medium High High Very High
Possible
L2
Not likely to occur
in normal Low Low Medium Medium High
Unlikely
circumstances
L1
May occur only in
exceptional Low Low Medium Medium Medium
Rare
circumstances