WORK ENVIRONMENT ASSESSMENT () all relevant boxes Date of assessment: DD/MM/YYYY Crystalline Silica Industry Controls: Excavation/Earth Moving Drilling Plant Respirator use Yes No Clay/Stone Processing Local exhaust ventilation (if Yes No Paving/Surfacing indoors) Mining Overalls / work clothing Yes No Construction Laundering by employer Yes No Abrasive Blasting Wash basins & showers (with hot & Yes No Foundry Casting cold water) Other (specify): ___________ Wet handling methods used where Yes No possible Personal hygiene: Clean Shaven Yes No Shower & change into clean Yes No clothes at end of shift BIOLOGICAL MONITORING RESULTS Include at least the previous two test results (if available) Date Tests performed Recommended Action and/or Comment 1. DD/MM/YYYY Last Chest X-Ray Results: Normal / Abnormal DD/MM/YYYY ________________________________________ 2. DD/MM/YYYY Spirometry Results: FEV1 ____________; FVC __________ FEV1/FVC __________________ 3. DD/MM/YYYY 4. DD/MM/YYYY 5. DD/MM/YYYY 6. DD/MM/YYYY 7. DD/MM/YYYY 8. DD/MM/YYYY RECOMMENDATIONS (by Medical Practitioner) () all relevant boxes Suitable for work with crystalline silica Counselling required Review workplace controls
WORK ENVIRONMENT ASSESSMENT () all relevant boxes Date of assessment: DD/MM/YYYY Crystalline Silica Industry Excavation/Earth Moving Drilling Plant Clay/Stone Processing Paving/Surfacing Mining Construction Abrasive Blasting Foundry Casting Other (specify): ___________ Controls: Respirator use Yes No Local exhaust ventilation (if indoors) Yes No Overalls / work clothing Yes No Laundering by employer Yes No Wash basins & showers (with hot & cold water) Yes No Wet handling methods used where possible Yes No Personal hygiene: Clean Shaven Yes No Shower & change into clean clothes at end of shift Yes No BIOLOGICAL MONITORING RESULTS Include at least the previous two test results (if available) Date Tests performed Recommended Action and/or Comment 1. DD/MM/YYYY Last Chest X-Ray DD/MM/YYYY Results: Normal / Abnormal ________________________________________ 2. DD/MM/YYYY Spirometry Results: FEV1 ____________; FVC __________ FEV1/FVC __________________ 3. DD/MM/YYYY 4. DD/MM/YYYY 5. DD/MM/YYYY 6. DD/MM/YYYY 7. DD/MM/YYYY 8. DD/MM/YYYY RECOMMENDATIONS (by Medical Practitioner) () all relevant boxes Suitable for work with crystalline silica Counselling required Review workplace controls
hazardous-chemicals-requiring-health-monitoring.docx