Projects Involving Carcinogenic or Highly Toxic Substances
Supplement to the University of Sydney Research Proposal Clearance Form
Please complete each section by ticking boxes and adding notes in the space provided as appropriate. Attach the
completed form to the Research Proposal Clearance Form (RPCF) and submit to the Research Office. Completion
of this form assists researchers to assess and control the risks associated with research. This is a requirement of the
Granting bodies and the University's ohsrm Program 1. It is also a prerequisite for the release of research funding.
Project title (exactly as it appears on RPCF):
Location of project (building and room number):
Chief Investigator (name and contact number):
Substance name:
Note: A permit from NSW WorkCover is required to use some carcinogens (refer to the attached list).
WorkCover requires 60 days notice of the proposed project commencement.
Substance is carcinogenic or highly toxic, but not Notifiable or Prohibited
Notifiable substance
Prohibited substance #
WorkCover has been notified of the intended carcinogen use via the prescribed form 2
WorkCover has issued an authorisation for the work
RISK ASSESSMENT
A material safety data sheet for the substance is held 3. This has been referenced in the project planning.
The hazard ?the substance is carcinogenic.
Route(s) of exposure: List:
Inhalation Target organs affected:
Ingestion Types of cancer caused:
Skin absorption Acute effects:
Substance form - liquid, powder etc.
Maximum volume held:
Concentration in use:
Volume in use:
Typical processes eg. weighing out,
decanting, pipetting etc.
Method of deactivating substance:
Hazardous waste generated:
Liquid Solid Gaseous/airborne
Description:
Work Environment
Please describe the suitability of the environment for the proposed work, including any shortcomings.
Space provided:
Bench & floor surfaces:
Traffic:
Temperature & ventilation:
Lighting:
Housekeeping:
Security of facility:
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Individuals involved
Consider each project team member (where they are known) and their capacity to do the work safely and effectively.
Name Role in team Experience & training Characteristics that
eg research assistant increase risk
Physical activities
Describe activity
Repetitive actions or long duration of task
Physical exertion
Bending, reaching or twisting
Sustained or uncomfortable posture(s)
RISK CONTROLS
The following list mirrors the hierarchy of hazard control. Tick relevant risk controls that will apply and provide
brief details where relevant eg, for restricted access, details may be "door locked when unattended"..
Details:
Elimination The benefit to be derived outweighs the risk from
using the substance
Substitution A less toxic substance is not available as an alternative
Isolation Secure facility with only authorized access
Designated work area within facility
Designated and secure storage for the substance
Spill tray and/or absorbent bench coat for bench work
Containers capped
Secondary containment for any transport outside
facility
Minimisation Smallest possible volumes
Dilution to lowest possible concentration
Shortest duration of task/exposure
Engineering Automated processes
Fume cupboard or fume/dust extraction system
Proper maintenance of equipment
Administration Restricted access
List of authorized personnel
Hazardous substances training for project personnel
Local induction training and orientation
Records kept of project team training
Hazard signposting at entry to facility (Uni standard)
Proper labeling of containers, including decanted
Ready access to MSDS
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Substance used only during normal business hours
Records kept of substance usage
Safe, standard operating procedures 4
Procedures
Work surfaces cleaned and decontaminated after use
Spill clean-up kit and procedures
First aid for known exposures
Removal of lab coat & gloves before exiting facility
Hand washing before exiting facility
Hazardous waste properly collected & disposed of 5
Work benches, under benches and passageways clear
of clutter
PPE ?Personal Laboratory coat or gown, closed at the front.
Protective Closed footwear
Equipment Disposable, impervious gloves
Respiratory protection
Eye or face protection
Eye wash and safety shower
Other controls:
RISK SUMMARY & CONCLUSION
Conclude by considering the risk assessment and choice of risk controls. Tick one only.
The risk posed is insignificant and unlikely to increase during the course of the project.
The risk is significant, but will be effectively controlled.
There is uncertainty about the level of risk.
The risk is significant and cannot be effectively controlled.
Comments:
RISK EVALUATION
The project is to be reviewed periodically, or whenever there is an incident or any significant change eg. new
equipment, personnel etc. This is to check that risk controls are still in place and working effectively.
Review dates:
Name of reviewer:
DECLARATION - FOR SUCCESSFUL GRANT APPLICATIONS
To be completed only if your project has been successful in attracting funding (Research Office will prompt).
I declare that the risk control measures listed above have been established, or will have been implemented prior
to the commencement of work with carcinogenic substances.
A copy of the WorkCover Permit is attached (applicable to notifiable and prohibited substances).
A copy of the safe, standard operating procedures is attached.
A copy of the emergency procedures dealing with spills, first aid etc. is attached.
Chief Investigator Head of Department
Name (please print):
Signature:
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NOTIFIABLE SUBSTANCES
Acrylonitrile [107-13-1]
Benzene [71-43-2]-when used as a feedstock containing more than 50% of benzene by volume
Cyclophosphamide [50-18-0] (cytotoxic drug)-when used in preparations for therapeutic use in hospitals and
oncological treatment facilities, and in manufacturing operations
3,3 -Dichlorobenzidine [91-94-1] and its salts (including 3,3 -Dichlorobenzidine dihydrochloride [612-83-9])
Diethyl sulfate [64-67-5]
Dimethyl sulfate [77-78-1]
Ethylene dibromide [106-93-4]-when used as a fumigant
4,4 -Methylene bis(2-chloroaniline) [101-14-4]-MOCA
2-Propiolactone [57-57-8]
o-Toluidine [95-53-4] and o-Toluidine hydrochloride [636-21-5]
Vinyl chloride monomer [75-01-4]
PROHIBITED SUBSTANCES
# These substances can be used for research and analytical purposes.
2-Acetylaminofluorene [53-96-3]
Aflatoxins-except in foods where specifically permitted under the Food Act 1989
4-Aminodiphenyl [92-67-1]
Amosite [12172-73-5] (brown asbestos)-except for removal, disposal, maintenance, encapsulation and enclosure
purposes and situations where amosite occurs naturally and is not used for any new application
Benzidine [92-87-5] and its salts (including benzidine dihydrochloride [531-85-1])
bis(Chloromethyl) ether [542-88-1]
Chloromethyl methyl ether [107-30-2] (technical grade which contains bis(chloromethyl) ether)
Chrysotile [12001-29-5] (white asbestos)-except when:
(a) used for the purpose of research or analysis, or
(b) being removed or disposed of, or being handled for storage or stored awaiting disposal, or
(c) encountered during non-asbestos mining, or
(d) comprising or included in an item being used for the purpose of a historical or educational display.
Crocidolite [12001-28-4] (blue asbestos)-except for removal, disposal, maintenance, encapsulation and enclosure
purposes and situations where crocidolite occurs naturally and is not used for any new application
4-Dimethylaminoazobenzene [60-11-7]
2-Naphthylamine [91-59-8] and its salts
4-Nitrodiphenyl [92-93-3]
REFERENCES
1. ohsrm Program ?the University's occupational health and safety risk management system, documents are
available on-line from: http://www.usyd.edu.au/risk/ohs_manual/ohsrm.shtml
2. WorkCover Notification Form for Work Involving the use of Carcinogenic Substances
http://www.workcover.nsw.gov.au/NR/rdonlyres/E5F8722E-2C12-469A-B5EE-
5D667E873604/0/gen_carcinog_subs_notif_4074.pdf
3. Chem Alert II hazardous substance database
4. Guidelines for Working with Hazardous Substances
5. Hazardous Waste Disposal Guidelines
3, 4 & 5 are available on-line from http://www.usyd.edu.au/risk/ohs_manual/haz-subs/index.shtml
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