Title Page
-
Site conducted
-
Product name
-
Site
-
Location
-
Conducted on
-
Prepared by
General Information
-
Department
-
Persons involved in COSHH Assessment
-
People at Risk
- Employees
- Students
- Vulnerable persons
- Others
- Contractors
-
other people at risk
Hazard Identification
-
Add + activity or work process
Process
-
undefined
-
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
- 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
- Skin Irritant
-
Indicate below which form the substance takes
- Gas
- Vapor
- Mist
- Fume
- Dust
- Liquid
- Soild
- Other state/form
-
Indicate below which route(s) of exposure the substance takes
- Inhalation
- Skin
- Eyes
- Ingestion
- Other state
-
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
- Dust mask
- Respirator
- Gloves
- Footwear
- Visor
- Goggles
- Overalls
- Other
-
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
- Skip
- Return to Depot
- Return to Supplier
- Other
-
Other means
Summary
-
Is the exposure adequately controlled?
-
Risk rating after following control measures
Completion
-
Full Name and Signature of the Inspector