COSHH Assessment (AA-HS-SF

Substance

• Describe the activity or work process:

• Location of activity or process:

• Conducted on

  Date

• Prepared by

• Storage Location:
  Address

• Quantity:

• Hazard Classification:

  Select Explosive Flammable Gas under pressure Oxidising Corrosive Acute Toxicity Hazardous to the environment Health Hazard Serious Health Hazard Not classified

  • Explosive
  • Flammable
  • Gas under pressure
  • Oxidising
  • Corrosive
  • Acute Toxicity
  • Hazardous to the environment
  • Health Hazard
  • Serious Health Hazard
  • Not classified

• Persons at risk:

  Employees/Operatives

  Contractors

  Public

• Hazard Type:

  Select Gas Vapour Mist Fume Dust Liquid Solid Other

  • Gas
  • Vapour
  • Mist
  • Fume
  • Dust
  • Liquid
  • Solid
  • Other

• Hazard Type:

• Application Method:

  Select Generated Dust Spraying Rolling Brushing/Wiping Trowel Mixing Pouring Pumping Manual Installation

  • Generated Dust
  • Spraying
  • Rolling
  • Brushing/Wiping
  • Trowel
  • Mixing
  • Pouring
  • Pumping
  • Manual Installation

• Frequency of Use:

  Constant

  Hourly

  Daily

  Weekly

  Infrequent

• Approximate frequency:

First Aid - Action to take if exposed (Section 4)

• General advice

• If inhaled

• In case of skin contact

• In case of eye contact

• If swallowed

• Any immediate medical attention and special treatment needed

  Yes

  No

Symptoms & Effects (Section 4, Section 8 and Section 11)

• Most important symptoms and effects, both acute and delayed:

• Any Workplace Exposure Limits?

  Workplace Exposure Limit

  No Exposure Limit

• Take a screenshot of the exposure limits related to the product. See example:

  

Fire Fighting Information (Section 5)

• Suitable extinguishing media:

  Select ABC Powder CO2 Foam Wet Chemical Water Fire Blanket Appropriate to local circumstances Water Jet

  • ABC Powder
  • CO2
  • Foam
  • Wet Chemical
  • Water
  • Fire Blanket
  • Appropriate to local circumstances
  • Water Jet

• Unsuitable extinguishing media:

  Select ABC Powder CO2 Foam Wet Chemical Water Fire Blanket Appropriate to local circumstances Water Jet

  • ABC Powder
  • CO2
  • Foam
  • Wet Chemical
  • Water
  • Fire Blanket
  • Appropriate to local circumstances
  • Water Jet

• Hazardous combustion products:

• Advice for firefighters:

Spillage Instructions (Section 6)

• PPE Required (Section 8):

  Select Hand Protection (Gloves) Face / Eye Protection Body Protection (e.g. Apron, Overalls) Mask / Respirator Other

  • Hand Protection (Gloves)
  • Face / Eye Protection
  • Body Protection (e.g. Apron, Overalls)
  • Mask / Respirator
  • Other

• Clean up Method:

Safe Handling & Storage (Section 7 and Section 10)

• Safe handling instructions:

• Safe storage instructions:

• Reactivity

  Yes

  No

• Chemical stability

  Yes

  No

• Possibility of hazardous reactions

  Yes

  No

• Conditions to avoid

  Yes

  No

• Incompatible materials

  Yes

  No

• Hazardous decomposition products

  Yes

  No

PPE Requirements (Section 8)

• PPE Required:

  Select Hand Protection (Gloves) Face / Eye Protection Body Protection (e.g. Apron, Overalls) Mask / Respirator Other

  • Hand Protection (Gloves)
  • Face / Eye Protection
  • Body Protection (e.g. Apron, Overalls)
  • Mask / Respirator
  • Other

• Type of Eye Protection:

• Type of Hand protection:

• EN Standard:

• Type of body protection:

• EN Standard

• Type of Respiratory Protection:

• Filter Type

• What other equipment is required:

Safe Disposal (Section 13)

• If SDS states that "Dispose of surplus and non-recyclable products via a licensed waste disposal contractor", the product should be classed has hazardous waste.

• Is this product classed as Hazardous Waste:

  Hazardous Waste

  General Waste

• Waste Code:

COSHH Sign Off

• COSHH Completed by:

  Sign

• Are there requirements of this assessment which may need further action? (e.g. purchasing suitable PPE, additional training for operatives, or looking for alternative products due to health risks)

  Yes

  No