EXPERIMENT REQUEST & RISK ASSESSMENT SHEET

TEACHER CODE:
Jamie Cordy

DAY & DATE REQUIRED:

Day:
Date:
12/12/14

LESSON/TIME:
Lesson 3 &4

CLASS / SUBJECT:
Year 7 Science

ROOM: 5
Outside on oval and surrounding area

NO. OF GROUPS:

Scientific Assistant
Required

TITLE / DESCRIPTION OF PRAC:

Mousetrap Racer Surface variations

/NO

EQUIPMENT / CHEMICAL LIST

APPARATUS / EQUIPMENT

QTY

Mousetrap car

Tape Measure

Recording Sheet

Pencil

Eraser

CHEMICALS / BIOLOGICALS

QTY

DISPOSAL
CODE

N/A

DISPOSAL METHODS refer to statements in Chemwatch / MSDSs to determine necessary procedures.

A. flush with running water down
the sink.
E. collect for reuse (eg. non-reacted
metal strips)

B. class room rubbish (nonhazardous solids)

F. package for refrigeration and later
disposal (eg. animal dissection
waste)

C. outside rubbish bins (eg. food and

other messy solids)
G. collect in labelled waste containers
for appropriate hazardous waste
disposal (eg. lead & silver compounds,
immiscible organics, etc)

D. broken glass bin

SPECIFIC RISK CONTROL MEASURES

RISK MINIMISATION STRATEGIES for all experiments and activities

Preparation
Class size is appropriate
Class has appropriate experience
Class groups are appropriately spaced

Emergency procedures have been

considered

Prior demonstration of skills is

necessary

Teacher has relevant previous

experience

Appropriate spillage control

methods are on hand

Hazards have been assessed

Number of groups is desirable

Organisation
Room is appropriate for the experiment

Movement of people has been

considered

All materials to be used have been

considered

Use of lab coat/apron necessary

Synthetics/parkers removed

Safety glasses /Goggles necessary

Presence of Scientific Assistant

Advantageous

Safe supervision and Personal Protection

Prior safety explanations are
necessary
Hair tied back
Need for students wearing contact
lenses to wear goggles

Jewellery removed as appropriate

Contact lenses removed

Complete, covered footwear

Experimental practices
Appropriate practices for minimum skin
contact

Amounts of chemicals are appropriate

Need to Inform students of hazards

involved

Need for good ventilation

Need for use of fume cupboard

Students have been reminded about:

Lighting and use of Bunsen Burners

Heating of liquids

Carrying glass wear

Heating in test tubes

Handling hot apparatus/liquids

Handling reagent bottles

CALCULATION OF THE RISK For all activities/experiments

(Save form as a document of your own, then reopen and move lines to required position.)

The risk is calculated after considering the Risk Minimisation strategies above.

ALMOST
CERTAIN

500
NUMEROUS

QUITE
POSSIBL
E

UNUSUAL

FATALITIES

RARE

INFREQUENT

OCCASIONAL

FATALITIES

CASUALTY
REMOTEL
Y

DISASTER

SUBSTANTIAL
VERY
SERIOUS

100

RISK

80
SERIOUS

60

MODERATE
RISK

TREATMENT
IMPORTANT

CONTINUOUS

200

FATALITY
SERIOUS
INJURY

VERY
HIGH RISK

HIGH RISK

MULTIPLE

FREQUENT

POSSIBLE

400
300

VERY RARE

BUT
POSSIBLE

CATASTROPHE

40

FIRST AID
TREATMENT

NOTICEABLE
20

CONCEIVABLE

RISK

BUT VERY

PERHAPS

UNLIKELY

PRACTICALLY
IMPOSSIBLE

10

ACCEPTABLE

EXPERIMENT RISK ASSESSMENT (Select the relevant aspects)

LOW RISK

SCORE IS CALCULATED AS LESS

THAN
30

Completion of page two and sign.

MEDIUM RISK

SCORE IS CALCULATED BETWEEN

30
AND 90

Specific identified activities Involving:

1.
2.
3.
Complete page two and give to the
Supervisor for signing

HIGH RISK
SCORE IS CALCULATED AS
GREATER THAN 90

Specific identified activities Involving:

1.
2.
3.

Complete page two and obtain Supervisor

signature.

SIGNATURES:
CALCULATED
RISK SCORE

TEACHER/LECTURER
JAMIE CORDY

DATE
12/12/14

SUPERVISOR/SENIOR

DATE
--/ --/-