Preliminary Risk Assessment

Please complete this form with the best information you currently have available. If further information becomes available, please submit a second form with the "revision" box selected.

If any part of the form is unclear, or if there are any materials or processes, the hazards of which you are unsure, then please contact the Office of Environmental Health and Safety at ehs.office@utoronto.ca or 416-973-4467 for assistance.

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Please review all categories and ensure that you check all applicable items from the following list: Is this a new or revised risk assesment? Please select one: New Revised First Name: Last Name: Phone No.  Enter a valid phone number. Example: 123-456-7890 Faculty/Department Other (please specify)Faculty of MedicineFaculty of ForestryHuman ResourcesFacilities and ServicesFaculty of Arts and ScienceUniversity of Toronto MississaugaUniversity of Toronto ScarboroughFaculty of NursingFaculty of DentistryFaculty of Applied Science and EngineeringAncillary ServicesOffice of the Governing CouncilLibrariesFaculty of PharmacyFaculty of Physical Education and HealthFaculty of Architecture and DesignOISE/UTFaculty of LawFaculty of Information StudiesFaculty of MusicFaculty of Social WorkFaculty of ManagementTransitional Year ProgramGraduate Institutes and Centres Other Faculty/Department Building and room number: To receive a copy of your checklist, please enter your e-mail address:  Enter a valid email address. Example: name@company.com To send a copy to your departmental contact, Director, Chair or Dean please enter email here:  Enter a valid email address. Example: name@company.com A AGENTS Please check ALL applicable equipment/agents or activities. To select multiple items, hold down the CONTROL key while left-clicking each item. Chemicals including all WHMIS classes, cryogenics, etc.highly toxic materials - LD50 < 100mg/kgBiological Agent (e.g., viruses, cell cultures, bacteria)CarcinogensRadioactive material (including sealed sources in gas chromatographs, moisture or density gauges)Teratogens - reproductive toxinsNovel chemicals or materials of unknown toxicity and/or exposure routesExplosives and highly reactive or unstable chemicalsEmission ( e.g., dust, particulates, odour, heat, hazardous material, etc.)Excessive Noise (> 85 dBA)Pressure (high or low - e.g., gas cylinders, boilers, vacuum)Temperature extremes (e.g. heat stress or hot surfaces; cold stress or cryogenic, etc.)AsbestosSilicaLeadMercury or compoundsNon-human primatesAnimals with transmissable diseasesHumans with transmissable diseasesNone CITY OF TORONTO PRIORITY SUBSTANCES - PLEASE SELECT ANY THAT ARE USED, MANUFACTURED OR RELEASED BY YOUR GROUP City of Toronto Priority Substances. To select multiple items, hold down the CONTROL key while left-clicking each item. Acetaldehyde || CAS: 75-07-0Acrolein || CAS: 107-02-8Benzene || CAS: 71-43-21,3-Butadiene || CAS: 106-99-0Cadmium(a) || CAS: 7440-43-9Carbon tetrachloride || CAS: 56-23-5Chloroform (Trichloromethane) || CAS: 67-66-3Chromium, Hexavalent(a) || CAS:7440-47-3Chromium, Non-hexavalent(a) || No CAS1,2-Dibromo ethane (Ethylene dibromideide) || CAS: 106-93-41,4-Dichlorobenzene || CAS: 106-46-71,2-Dichloroethane (Ethylene dichloride) || CAS: 107-06-2Dichloromethane (Methylene chloride) || CAS: 75-09-2Formaldehyde || CAS: 50-00-0Lead(a) || CAS: 7439-92-1Manganese(a) || CAS: 7439-96-5Mercury(a) || CAS: 7439-97-6Nickel(a) || 7440-02-0Tetrachloroethylene (Perchloroethylene) || CAS: 127-18-4Trichloroethylene || CAS: 079-01-6Vinyl chloride || CAS: 75-01-4Polycyclic Aromatic Hydrocarbons || CAS: N/ANitrogen Oxides(c) (NOx) || CAS: 11104-93-1PM2.5 || CAS: N/AVOC (Volatile Organic Compounds) || CAS: N/ANone Other Agents: Other Agents: B EQUIPMENT Please check ALL applicable equipment. To select multiple items, hold down the CONTROL key while left-clicking each item. AutoclaveCentrifugeCutting or puncture devicesEquipment with exposed moving partstransportation equipment usage - cars, trucks etc.Excessive weight/floor loading (>80 pounds per ft2)LaserLifting or rigging deviceSpecial Personal Protective Equipment required (ie. beyond labcoat, goggles and gloves)Sharps (e.g. syringes, blades, needles)X-ray equipmentopen UV light equipmentNo equipment hazards Other Equipment: Other Equipment: C ACTIVITIES: Please check ALL applicable activities. To select multiple items, hold down the CONTROL key while left-clicking each item. Confined or restricted spaceElevated height (> 3 metres off ground)Working alone or in isolationOff campus activitiesTravelling outside CanadaWeldingElectrical work (especially high voltage)Work with explosive materialsMaintenance work on equipmentWorking with fireWorking with laddersLifting heavy objectsRepeated liftingWorking from scaffoldsProducing hazardous waste - especially off campusNo hazardous activities Other Activities: Other Activities: