Title Page

  • Client / Site

  • Location
  • Conducted on

  • Prepared by

General Information

  • Department

  • Persons involved in COSHH Assessment

  • People at Risk

  • other people at risk

Hazard Identification

  • Add + activity or work process

  • Process
  • How long will it take?

  • How often will it be repeated?

  • How much substance is used?

  • Locaton of the process or work being carried out

  • Hazard

  • Indicate below which form the substance takes

  • Indicate below which route(s) of exposure the substance takes

  • Workplace Exposure Limits (WELs)

  • Long-term exposure level

  • Short-term exposure level

  • List the risks to health below from exposure to the substance

Control Measures

  • List below control measures eg extraction, ventilation, supervision, include additonal controls for vulnerable persons where necessary

  • Is health surveillance or monitoring required? (remember health surveillance may be required for vulnerable persons eg pregnant/young workers those with asthma, dermatitis etc)

Personal Protective Equipment

  • Identify type and specification

  • Other PPE

  • Provide standard measures for each PPE required

First Aid Measures

  • Write first measures when in contact with these chemicals

Storage and Disposal of Substances and Contaminated Containers

  • How do you store these substances?

  • Means of Disposing Hazardous Waste

  • Other means


  • Is the exposure adequately controlled?

  • Risk rating after following control measures


  • Full Name and Signature of the Inspector

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.