General Information


Persons involved in COSHH Assessment

People at Risk

other people at risk

Hazard Identification

Add + activity or work 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

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
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.