COSHH Risk Assessment Form

• COSHH Risk Assessment

• Name of Substance

• COSHH Reference

• Client / Site

• Conducted on

  Date

• Prepared by

General Information

• Supplied by

• Description of Substance

• Department

• People at Risk

  Select Employees Vulnerable persons New and Expectant Mothers Young Persons Contractors Public Others

  • Employees
  • Vulnerable persons
  • New and Expectant Mothers
  • Young Persons
  • Contractors
  • Public
  • Others

• 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?

  0-1liter

  1 - 25liter

  25liter+

• Hazard

  Select Acute Toxicity Very Toxic (fatal) Corrosive Harmful Explosive Serious eye irritation Respiratory Sensitiser Serious long term health hazard Oxidising Flammable Highly Flammable Extremely Flammable Dangerous to the environment Gasses under pressure

  • Acute Toxicity
  • Very Toxic (fatal)
  • Corrosive
  • Harmful
  • Explosive
  • Serious eye irritation
  • Respiratory Sensitiser
  • Serious long term health hazard
  • Oxidising
  • Flammable
  • Highly Flammable
  • Extremely Flammable
  • Dangerous to the environment
  • Gasses under pressure

• Indicate below which form the substance takes

  Select Gas Vapor Mist Fume Dust Liquid Soild Other state/form

  • Gas
  • Vapor
  • Mist
  • Fume
  • Dust
  • Liquid
  • Soild
  • Other state/form

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

  Select Inhalation Skin Eyes Ingestion Other state

  • Inhalation
  • Skin
  • Eyes
  • Ingestion
  • Other state

• Workplace Exposure Limits (WELs)

• Long-term exposure level

• Short-term exposure level

Control Measures

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

  Select Extraction + Thorough Examination of Extraction Adequate Ventilation Supervision PPE Training Air Quality Assessments Suitable Storage Health Surveillance Suitable Storage Good Housekeeping

  • Extraction + Thorough Examination of Extraction
  • Adequate Ventilation
  • Supervision
  • PPE
  • Training
  • Air Quality Assessments
  • Suitable Storage
  • Health Surveillance
  • Suitable Storage
  • Good Housekeeping

• What health surveillance is required if any?

  Select Skin Respiratory Hearing Eye Sight Blood Tests HAVS Other

  • Skin
  • Respiratory
  • Hearing
  • Eye Sight
  • Blood Tests
  • HAVS
  • Other

Personal Protective Equipment

• Identify type and specification

  Select Respirator Gloves Footwear Eye Protection Protective Clothing Other

  • Respirator
  • Gloves
  • Footwear
  • Eye Protection
  • Protective Clothing
  • Other

• Other PPE

• Provide standard measures for each PPE required

First Aid Measures

• Contact with eyes

• Contact with skin

• Inhalation

• Ingestion

Storage and Disposal of Substances and Contaminated Containers

• How do you store these substances?

• Means of Disposing Hazardous Waste

  Select Skip Return to Depot Return to Supplier Other

  • Skip
  • Return to Depot
  • Return to Supplier
  • Other

• Other means

Summary

• Is the exposure adequately controlled?

  Yes

  No

  N/A

• Risk rating after following control measures

  HIGH

  MEDIUM

  LOW

Completion

• Full Name and Signature of the Inspector

  Sign