Workbook for Designated Substance Assessments
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366-BPV-01-IMOT © 2024, Workplace Safety & Prevention Services (WSPS)
1 877 494 WSPS (9777) | 905 614 1400 | WSPS.CA
5. If YES to Question 3, indicate how workers could be exposed (check all that apply):
Inhalation Skin absorption
Ingestion Skin contact
6. If NO, to Question 3, is there a likelihood of the chemical to escape due to leaks, accidents, etc.?
YES NO
Are workers likely to be exposed? YES NO
Conclusions
Are there any activities/situations where exposure by any route is likely? YES NO
If NO, no further action is necessary. Date completed: ______________________________________
If YES an assessment is necessary. Proceed to Section III.
Note: If protection against exposure has been controlled by engineering controls that can fail or deteriorate
for any reason, or to a work/hygiene practice, an assessment is necessary, Proceed to Section III.
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