Student Risk Assessment to Accompanying Taught Programmes Ethics Applications

Student Risk Assessment to Accompanying Taught Programmes Ethics Applications

Research Programmes should not complete this form

Student’s surname
Student’s forename(s)
School
Degree
Title of Project
Brief description of the project
Supervisor’s name
Reserve supervisor in case of absence
Locations where work will be carried out

It is the responsibility of the PI / Supervisor to ensure the risk assessment is suitable and sufficient and that risk assessments are reviewed should any significant changes to the project / research be made.

Risk assessment (RA) tracking
Hazard / RA required / RA complete / Risk level as identified in RA / Authorised as suitable and sufficient by supervisor
Initial Risk Assessment / 
Physical / Mechanical / Electrical / Animal
Biological Microorganisms
Chemical
Radiation
Travel / Fieldwork
Host Organisation
I shall be working in the establishment named below (where applicable):
Name:
Address:
Tel:
Emergency Contact Details
Role / Name / Telephone & email
Student
Academic Supervisor
Host organisation Supervisor (where applicable)

Please complete the following risk assessment forms as dictated by the proposed project.

Guidance on how to complete the assessments can be found in the Project RA handbook.

Please delete the sections that are irrelevant to your project.

Contents

Initial Risk Assessment

Physical / Mechanical / Electrical / Aminal Risk Assessment

Biological Risk Assessment – Microorganisms (Bacteria / Fungi)

Genetically Modified Organism (GMO) Risk Assessment.

Biological Risk Assessment (Animals)

Chemical Risk Assessment (COSHH)

DSEAR Risk Assessment

Radiation / Laser Risk Assessment

Travel / Fieldwork Risk Assessment

Initial Risk Assessment

Location: / Task/Activity/Environment: / Date of Assessment:
Identify Hazards which could cause harm: / Identify risks,i.e. what could go wrong if hazards cause harm:
No. /

Hazard

No.

Risk

Physical / mechanical / electrical / animal
Biological
Chemical
Radiation / Lasers
Lone working
Travel / Fieldwork
Disposal of waste material
List groups of people who could be affected: / What numbers of people are involved?
What existing precautions are in place to reduce risks? / Risk level with existing precautions
What additional actions are required to ensure precautions are implemented/effective or to reduce the risk further? /

Risk level with additional precautions

Is health surveillance required? YES/NO /

If YES, please detail:

Who will be responsible for implementing the
precautions: / By When:
Completed by: / Signed:
Record of annual review:

Risk Rating:

Increasing Consequence
/ 5 / 10 / 15 / 20 / 25
4 / 8 / 12 / 16 / 20
3 / 6 / 9 / 12 / 15
2 / 4 / 6 / 8 / 10
1 / 2 / 3 / 4 / 5
Increasing Likelihood

/ 17-25Unacceptable – Stop activity and make immediate improvements/seek further advice
10-16Tolerable – look to improve within specified timescale
5-9Adequate – Look to improve at next review
1-4Acceptable - No further action, but ensure controls are maintained

Guide to using the risk rating table:

Consequences / Likelihood
1 Insignificant – no injury / 1 Very unlikely – 1 in a million chance of it happening
2 Minor – minor injuries / 2 Unlikely – 1 in 100,000 chance of it happening
3 Moderate – up to three days absence / 3 Fairly likely – 1 in 10,000 chance of it happening
4 Major – more than three days absence / 4 Likely – 1 in 1,000 chance of it happening
5 Catastrophic – death or disabling / 5 Very likely – 1 in 100 chance of it happening

Physical / Mechanical / Electrical / Biological (Animals) Risk Assessment

Location: / Task/Activity/Environment: / Date of Assessment:
Identify hazards which could cause harm: / Identify risks = what could go wrong if hazards cause harm:
No. /

Hazard

No.

Risk

List groups of people who could be affected: / What numbers of people are involved?
What existing precautions are in place to reduce risks? / Risk level with existing precautions
No.
What additional actions are required to ensure precautions are implemented/effective or to reduce the risk further? /

Risk level with additional precautions

No.
Is health surveillance required? YES/NO /

If YES, please detail:

Who will be responsible for implementing
precautions: / By When:
Completed by: / Signed:
Record of annual review:

Risk Rating:

Guide to using the risk rating table:

Biological Risk Assessment– Microorganisms

Step 1 – Obtain the Information
Microorganism / Biological Hazard Classification / Locations / Possible Route of Entry
(Inhalation, Ingestion, Absorption, Vector, Sharps) / GMO Status / Disposal route / Risk level
1 / N/A 1 2 3 / Yes / No
2 / N/A 1 2 3 / Yes / No
3 / N/A 1 2 3 / Yes / No
4 / N/A 1 2 3 / Yes / No
5 / N/A 1 2 3 / Yes / No
6 / N/A 1 2 3 / Yes / No
7 / N/A 1 2 3 / Yes / No
8 / N/A 1 2 3 / Yes / No

If any or the organisms hold a GMO status then your project / research must be referred to the GMO Committee for their approval.

Step 2 – Assess the Risk
Identify hazards which could cause harm: / Identify risks = what could go wrong if hazards cause harm:
No. /

No.

Risk level with additional precautions

No.
Is health surveillance required? YES/NO /

If YES, please detail:

Is immunisation required?

YES/NO

If YES, please detail:

Who will be responsible for implementing
precautions: / By When:

Completed by: / Signed:
Record of annual review:

Risk Rating:

Guide to using the risk rating table:

Genetically Modified Organism (GMO) Risk Assessment.

Brief description of the activity and the reason for carrying it out.
As briefly as possible, your description must answer the following: What do you wish to do? To what? How? Why do you want to do it? What is the importance of the outcomes? Most of the answers may be self-evident to you but, legally, they are now required to be understandable by anyone.
Hazard identification in respect of human health and environmental safety
Host(s): / If the host organism(s) are not listed in the SACGM compendium ( as disabled, or especially disabled, and you claim it is/they are, you must provide evidence from either the literature or supplier to support your claim.
Vector(s): / If the vector is not listed in the SACGM compendium as mobilisation defective, or non-mobilisable, and you claim it is you must provide evidence from either the literature or supplier to support your claim.
Inserted sequence(s): / What do the sequences determine? Will a biologically active protein such as an enzyme, hormone, receptor etc. be expressed? If so could it/they be transferred to an unintended host (human or wild type organism) in the event of an accident? If this were to occur could harm be realised? If not, you must say why not.
Final GMO(s): / If you claim the final GMO to be less harmful, or no more harmful than the unmodified host, you must justify.
Escape from containment
(a) Consider the possible severity of harm to humans
(b) Consider the possible severity of harm to animals, plants or ecosystems
Provisional assignment of the class of containment.
The provisional class [and containment level] for this organism is:
Requirement for a disaster plan?
The risk assessment indicates that no disaster plan is required.
The disaster plan [attached] has been complied and the following authorities [have been/will be] notified accordingly.
(Delete the statement that is not applicable)
Assignment of the final activity class.
Are additional control measures required?
Describe in detail any deviation from the above and state why it is necessary
Training and authorisation:
The final classification of the organism is:
Signature of the applicant: Date:
Accepted
The Genetically Modified Organisms Sub-Committee of the School of Environmental Life Sciences at The University of Salford agrees that the above is an accurate assessment of the risks associated with this activity.
Signatures: Date:
Safety Committee Chair ______
Local GMO Safety Advisor ______
Rejected
The committee does not agree with the risk assessment and asks you to consider re-application after further consideration of the following points:
Registration and notification,
To be completed in collaboration with the local GMO Safety Advisor and (where necessary) with the University Safety Advisor.
A copy of the notification and risk assessment has been sent to the:
Biological Safety Officer [date] ______
University Safety Advisor [date] ______
The GMO Safety Advisor is required to inspect containment facilities for new applications and their first use within any Class 1 laboratory.
Date of visit: ______

Chemical Risk Assessment (COSHH).

No / Product / Chemical / MSDS present / Risk Phrases (R…) / Safety Phrases (S…) / Flammable/ highly flammable / explosive / oxidising? / What precautions are required? / What PPE is required? / Risk level
1
2
3
4
5
6
7
8
9
10
Enter the product brand name or chemical name. / Make sure the MSDS is available in the area in which you are working. / These should be on the MSDS / These should be on the MSDS / Please state which if applicable. / E.g. Fume cabinet / specialised storage cabinets / segregation of chemicals. / E.g. gloves / goggles / lab coats. / Use the table below to calculate this.

If any medium, high or critical risks are identified you will need to implement additional control measures to lower the risk.

No / Product / Chemical / Risk level in 1st table / What additional precautions are required? / Risk level
1
2
3
4
5
6
7
8
9
10
Use the corresponding number and product name from the first table / Eg. use and alternative chemical / process, reduce the quantities and exposure levels / Use the table below to calculate this after the additional precautions have been implemented.
Completed by: / Signed:
Record of annual review:

Risk Rating:

Guide to using the risk rating table:

DSEAR Risk Assessment.

Please put an ‘x’ in those that apply.

/ Explosive Chemicals that explode
Explosive, self-reactive, organic peroxide / R1 to R19 /
R1: Explosive when dry
R2: Risk of explosion by shock, friction, fire or other sources of ignition
R3: Extreme risk of explosion by shock, friction, fire or other sources of ignition
R4: Forms very sensitive explosive metallic compounds
R5: Heating may cause an explosion
R6: Explosive with or without contact with air
R7: May cause fire
R8: Contact with combustible material may cause fire
R9: Explosive when mixed with combustible material
R10: Flammable
R11: Highly flammable
R12: Extremely flammable
R14: Reacts violently with water
R15: Contact with water liberates extremely flammable gases
R16: Explosive when mixed with oxidising substances
R17: Spontaneously flammable in air
R18: In use, may form flammable/explosive vapour-air mixture
R19: May form explosive peroxides

/ Oxidising Chemicals that react exothermically with other chemicals
Oxidising gases, oxidising liquids, oxidising solids

/ Extremely flammable Chemicals that have an extremely low flash point and boiling point, and gases that catch fire in contact with air or highly flammable Chemicals that may catch fire in contact with air, only need brief contact with an ignition source, have a very low flash point or evolve highly flammable gases in contact with water
Flammable gasses, flammable liquids, flammable solids, flammable aerosols, organic peroxides, self-reactive, pyrophoric, self-heating, contact with water emits flammable gas
R30
Can become highly flammable in use /
R44
Risk of explosion if heated under confinement /
R14/15
Reacts violently with water, liberating extremely flammable gases /
R15/29
Contact with water liberates toxic, extremely flammable gases /
DSEAR (2002) RISK ASSESSMENT
Substance(s) / Process:
Manufacturers Safety Data Sheet(s) available? / Yes / No
MSDS stored: / Electronically / Paper copy
Does the substance / process match any of the Risk Phrases mentioned above / Yes / No
Is the substance: / Flammable
Highly flammable
Liquid / Extremely flammable
Gas / Explosive
Solid / Oxidising
Powder / Flashpoint below 32oc
If any of the risk phrases / symbols, or boxes in the red sectionapply to the substance(s) you are using then please fill in the next section. If not, no further action is required under DSEAR.
Approximate quantity to be used?
Storage and handling arrangements (including any waste storage).
Measures in place to stop explosive atmosphere forming.
Ignition sources.
Measures in place to stop ignition of substances / atmospheres.
Likelihood of fire or explosion (A). / (see column A below)
Anticipated scale of accidental fire or explosion after control measures have been implemented (B). / (see column B below)
Risk level (A x B) / If greater than 7, identify additional actions to reduce risk further
Additional control measures required
Likelihood and scale after additional controls are in place (A x B)
Completed by: / Signed:
Record of annual review:

Risk Rating:

Guide to using the risk rating table:

Radiation / Laser Risk Assessment

Location: / Task/Activity/Environment: / Date of Assessment:
Identify Hazards which could cause harm: / Identify risks = what could go wrong if hazards cause harm:
No. /

Hazard

No.

Risk

Risk level with additional precautions

No.
Is health surveillance required? YES/NO /

If YES, please detail:

Who will be responsible for implementing
precautions: / By When:
Laser Inspection Form / Date:
Building & room number: / Type:
Make: / Mode:
Model: / 1
Serial No.: / Max Power:
Precautions / Class 1 / Class 1M / Class 2 / Class 2M / Class 3R / Class 3B / Class 4
Remote Interlock
Key Control
Emission indicator
Beam Shutter
Beam Stop
Beam Level
Beam Enclosure
Eye Protection
Protective Clothing
Eye Examinations
Training
Laser Labels
Door Signs
*Shaded boxes do not apply to that class of laser.
Authorised Users
(please list):
Completed by: / Signed:
Record of annual review:

Risk Rating:

Guide to using the risk rating table:

Travel / Fieldwork Risk Assessment

This form should be completed in conjunction with the University Travel and Fieldwork Policy and Code of Practice

Destination(s)
Date of trip / From: _ _ : _ _ hrs on _ _ / _ _ / _ _
To: _ _ : _ _ hrs on _ _ / _ _ / _ _
Number of participants
First Aider
(where required)
Emergency Contact in School / Or Maxwell Control (Security) +44 (0)161 29 5 33 33 out of hours.
Potential Hazard / Existing Controls / Risk Level / Additional Controls
(if existing risk level is med or above) / Risk Level
Weather conditions
Terrain
Water (tides / deep water / currents etc.)
Harmful substances (chem. or bio.)
Animals
Danger from traffic / site vehicles
Industrial processes / plant etc.
Transport to and from site
Transport on site
Crime
Other
(please state)

NOTE: please use the table on the next page to determine risk levels

For destinations with medium (or above) risk ratings from Control Risks website () please attach a copy of their advice and complete the additional assessment as per the Travel and Fireldwork Policy / Code of Practice.

Completed by: / Signed:
Record of annual review:

Risk Rating:

Guide to using the risk rating table: