Culligan Working with Hazardous Substances (COSHH) Assessment Form

• Site conducted

  Select

• Ref No.

• Date of assessment

  Date

• Task Name:

• Add details of the task here - for example, a video of the operation, Operational process (in a .pdf format)

Chemical Name (s)

• Are Safety Data Sheets available in the asset?

  Yes

  No

• You should not proceed without a current safety data sheet. Please source and add the .pdf document to the Asset

• Issue number

  Issue 1

  Issue 2

  Issue 3

  Issue 4

  Issue 5

• Purpose of new issue

  Select general review (2 years since last review) Due to an accident Due to change in process Risk assessment no longer suitable

  • general review (2 years since last review)
  • Due to an accident
  • Due to change in process
  • Risk assessment no longer suitable

• Add detailed description of review

• Prepared by

• Procedure (How are you going to use this product)

Chemical Information

• Hazard ID

  Select Corrosive Environmental Hazard Explosive Flammable Compressed Gas Health Hazard Caution/Danger Oxidiser Toxic No Hazards Applicable

  • Corrosive
  • Environmental Hazard
  • Explosive
  • Flammable
  • Compressed Gas
  • Health Hazard
  • Caution/Danger
  • Oxidiser
  • Toxic
  • No Hazards Applicable

• Corrosive to metals and can cause severe skin burns and eye damage.

  

• Toxic to aquatic life with lasting effects

  

• Explosives may explode in fire/heat together with risk of projectiles.

  

• Flammable gasses, aerosols, liquid, vapours and solids.

  

• Severe Health hazards and may cause repiratory issues, dizziness and skin/reactions. Can be harmful if swallowed/inhaled or contact with skin.

  

• Compressed gasses may explode if heated with projectile/fire risk. Refrigerated gasses may cause cold burns/injuries.

  

• Health hazards and may cause repiratory issues, dizziness and skin/reactions. Can be harmful if swallowed/inhaled or contact with skin.

  

• Toxic/Fatal if swallowed, inhaled and contact with skin

  

• Oxiders may cause or intensify fire and can explode.

  

H Codes

• H codes (Physical Hazards)

  Select No physical hazard associated with this chemical H200: Unstable explosive H201: Explosive; mass explosion hazard H202: Explosive; severe projection hazard H203: Explosive; fire, blast or projection hazard H204: Fire or projection hazard H205: May mass explode in fire H206: Fire, blast or projection hazard; increased risk of explosion if desensitizing agent is reduced H207: Fire or projection hazard; increased risk of explosion if desensitizing agent is reduced H208: Fire hazard; increased risk of explosion if desensitizing agent is reduced H220: Extremely flammable gas H221: Flammable gas H222: Extremely flammable material H223: Flammable material H224: Extremely flammable liquid and vapour H225: Highly flammable liquid and vapour H226: Flammable liquid and vapour H227: Combustible liquid H228: Flammable solid H229: Pressurized container: May burst if heated H230: May react explosively even in the absence of air H231: May react explosively even in the absence of air at elevated pressure and/or temperature H232: May ignite spontaneously if exposed to air H240: Heating may cause an explosion H241: Heating may cause a fire or explosion H242: Heating may cause a fire H250: Catches fire spontaneously if exposed to air H251: Self-heating; may catch fire H252: Self-heating in large quantities; may catch fire H260: In contact with water releases flammable gases which may ignite spontaneously H261: In contact with water releases flammable gas H270: May cause or intensify fire; oxidizer H271: May cause fire or explosion; strong oxidizer H272: May intensify fire; oxidizer H280: Contains gas under pressure; may explode if heated H281: Contains refrigerated gas; may cause cryogenic burns or injury H290: May be corrosive to metals

  • No physical hazard associated with this chemical
  • H200: Unstable explosive
  • H201: Explosive; mass explosion hazard
  • H202: Explosive; severe projection hazard
  • H203: Explosive; fire, blast or projection hazard
  • H204: Fire or projection hazard
  • H205: May mass explode in fire
  • H206: Fire, blast or projection hazard; increased risk of explosion if desensitizing agent is reduced
  • H207: Fire or projection hazard; increased risk of explosion if desensitizing agent is reduced
  • H208: Fire hazard; increased risk of explosion if desensitizing agent is reduced
  • H220: Extremely flammable gas
  • H221: Flammable gas
  • H222: Extremely flammable material
  • H223: Flammable material
  • H224: Extremely flammable liquid and vapour
  • H225: Highly flammable liquid and vapour
  • H226: Flammable liquid and vapour
  • H227: Combustible liquid
  • H228: Flammable solid
  • H229: Pressurized container: May burst if heated
  • H230: May react explosively even in the absence of air
  • H231: May react explosively even in the absence of air at elevated pressure and/or temperature
  • H232: May ignite spontaneously if exposed to air
  • H240: Heating may cause an explosion
  • H241: Heating may cause a fire or explosion
  • H242: Heating may cause a fire
  • H250: Catches fire spontaneously if exposed to air
  • H251: Self-heating; may catch fire
  • H252: Self-heating in large quantities; may catch fire
  • H260: In contact with water releases flammable gases which may ignite spontaneously
  • H261: In contact with water releases flammable gas
  • H270: May cause or intensify fire; oxidizer
  • H271: May cause fire or explosion; strong oxidizer
  • H272: May intensify fire; oxidizer
  • H280: Contains gas under pressure; may explode if heated
  • H281: Contains refrigerated gas; may cause cryogenic burns or injury
  • H290: May be corrosive to metals

• H Codes (Health Hazards)

  Select No health hazards apply to this chemical H300: Fatal if swallowed H301: Toxic if swallowed H302: Harmful if swallowed H303: May be harmful if swallowed H304: May be fatla if swallowed and enters airways H305: May be harmful if swallowed and enters airways H310: Fatal in contact with skin H311: Toxic in contact with skin H312: Harmful in contact with skin H313: May be harmful in contact with skin H314: Causes severe skin burns and eye damage H315: Causes skin irritation H316: Causes mild skin irritation H317: May cause an allergic skin reaction H318: Causes serious eye damage H319: Causes serious eye irritation H320: Causes eye irritation H330: Fatal if inhaled H331: Toxic if inhaled H332: Harmful if inhaled H333: May be harmful if inhaled. H334: May cause allergy or asthma symptoms or breathing difficulties if inhaled. H335: May cause respiratory irritation H336: May cause drowsiness or dizziness H340: May cause genetic defects H341: Suspected of causing genetic defects H350: May cause cancer H351: Suspected of causing cancer H360: May damage fertility or unborn child H361: Suspected of damaging fertility or the unborn child H361d: Suspected of damaging the unborn child H362: May cause harm to breast-fed children H370: Causes damage to organs H371: May cause damage to organs H372: Causes damage to organs through prolonged or repeated exposure H373: May cause damage to organs through prolonged or repeated exposure

  • No health hazards apply to this chemical
  • H300: Fatal if swallowed
  • H301: Toxic if swallowed
  • H302: Harmful if swallowed
  • H303: May be harmful if swallowed
  • H304: May be fatla if swallowed and enters airways
  • H305: May be harmful if swallowed and enters airways
  • H310: Fatal in contact with skin
  • H311: Toxic in contact with skin
  • H312: Harmful in contact with skin
  • H313: May be harmful in contact with skin
  • H314: Causes severe skin burns and eye damage
  • H315: Causes skin irritation
  • H316: Causes mild skin irritation
  • H317: May cause an allergic skin reaction
  • H318: Causes serious eye damage
  • H319: Causes serious eye irritation
  • H320: Causes eye irritation
  • H330: Fatal if inhaled
  • H331: Toxic if inhaled
  • H332: Harmful if inhaled
  • H333: May be harmful if inhaled.
  • H334: May cause allergy or asthma symptoms or breathing difficulties if inhaled.
  • H335: May cause respiratory irritation
  • H336: May cause drowsiness or dizziness
  • H340: May cause genetic defects
  • H341: Suspected of causing genetic defects
  • H350: May cause cancer
  • H351: Suspected of causing cancer
  • H360: May damage fertility or unborn child
  • H361: Suspected of damaging fertility or the unborn child
  • H361d: Suspected of damaging the unborn child
  • H362: May cause harm to breast-fed children
  • H370: Causes damage to organs
  • H371: May cause damage to organs
  • H372: Causes damage to organs through prolonged or repeated exposure
  • H373: May cause damage to organs through prolonged or repeated exposure

• H Codes (Environmental Hazards)

  Select No Environmental hazards apply to this chemical H400: Very toxic to aquatic life H401: Toxic to aquatic life H402: Harmful to aquatic life H410: Very toxic to aquatic lift with long lasting effects H411: Toxic to aquatic life with long lasting effects H412: Harmful to aquatic life with long lasting effects H413: May cause long lasting harmful effects to aquatic life H420: Harms public health and the environment by destroying ozone in the upper atmosphere H441: Very toxic to terrestrial invertebrates

  • No Environmental hazards apply to this chemical
  • H400: Very toxic to aquatic life
  • H401: Toxic to aquatic life
  • H402: Harmful to aquatic life
  • H410: Very toxic to aquatic lift with long lasting effects
  • H411: Toxic to aquatic life with long lasting effects
  • H412: Harmful to aquatic life with long lasting effects
  • H413: May cause long lasting harmful effects to aquatic life
  • H420: Harms public health and the environment by destroying ozone in the upper atmosphere
  • H441: Very toxic to terrestrial invertebrates

• European Union Supplementary Hazard Statements List

  Select No European Union Supplementary Hazard Statements EUH001 Explosive when dry EUH006 Explosive with or without contact with air EUH014 Reacts violently with water EUH018 In use, may form flammable/explosive vapour-air mixture EUH019 May form explosive peroxides EUH044 Risk of explosion if heated under confinement EUH029 Contact with water liberates toxic gas EUH031 Contact with acids liberates toxic gas EUH032 Contact with acids liberates very toxic gas EUH066 Repeated exposure may cause skin dryness or cracking EUH070 Toxic by eye contact EUH071 Corrosive to the respiratory tract EUH059 Hazardous to the ozone layer EUH201 Contains lead. Should not be used on surfaces liable to be chewed or sucked by children EUH201A Warning! Contains lead EUH202 Cyanoacrylate. Danger. Bonds skin and eyes in seconds. Keep out of the reach of children EUH203 Contains chromium (VI). May produce an allergic reaction EUH204 Contains isocyanates. May produce an allergic reaction EUH205 Contains epoxy constituents. May produce an allergic reaction EUH206 Warning! Do not use together with other products. May release dangerous gases (chlorine) EUH207 Warning! Contains cadmium. Dangerous fumes are formed during use. See information supplied by the manufacturer. Comply with the safety instructions EUH208: Contains (name of sensitising substance). May produce an allergic reaction EUH209: Can become highly flammable in use EUH209A: Can become flammable in use EUH210: Safety data sheet available on request EUH401: To avoid risks to human health and the environment, comply with the instructions for use

  • No European Union Supplementary Hazard Statements
  • EUH001 Explosive when dry
  • EUH006 Explosive with or without contact with air
  • EUH014 Reacts violently with water
  • EUH018 In use, may form flammable/explosive vapour-air mixture
  • EUH019 May form explosive peroxides
  • EUH044 Risk of explosion if heated under confinement
  • EUH029 Contact with water liberates toxic gas
  • EUH031 Contact with acids liberates toxic gas
  • EUH032 Contact with acids liberates very toxic gas
  • EUH066 Repeated exposure may cause skin dryness or cracking
  • EUH070 Toxic by eye contact
  • EUH071 Corrosive to the respiratory tract
  • EUH059 Hazardous to the ozone layer
  • EUH201 Contains lead. Should not be used on surfaces liable to be chewed or sucked by children
  • EUH201A Warning! Contains lead
  • EUH202 Cyanoacrylate. Danger. Bonds skin and eyes in seconds. Keep out of the reach of children
  • EUH203 Contains chromium (VI). May produce an allergic reaction
  • EUH204 Contains isocyanates. May produce an allergic reaction
  • EUH205 Contains epoxy constituents. May produce an allergic reaction
  • EUH206 Warning! Do not use together with other products. May release dangerous gases (chlorine)
  • EUH207 Warning! Contains cadmium. Dangerous fumes are formed during use. See information supplied by the manufacturer. Comply with the safety instructions
  • EUH208: Contains (name of sensitising substance). May produce an allergic reaction
  • EUH209: Can become highly flammable in use
  • EUH209A: Can become flammable in use
  • EUH210: Safety data sheet available on request
  • EUH401: To avoid risks to human health and the environment, comply with the instructions for use

Control Measures:

• General - For your safety and the safety of others, whilst using/applying/mixing this chemical "No Naked Flames, Smoking, Food/Drink and Mobile Phones"

  

• Basic Personal Protective Equipment (PPE) must be worn in accordance with local site rules.

• What PPE is required for this task?

  Select Hearing Protection Eye Protection Respiratoty Protection Hand Protection Head Protection Fall from Height protection Protective Clothing/ Coveralls Foot Protection Hi Visibility Clothing Other

  • Hearing Protection
  • Eye Protection
  • Respiratoty Protection
  • Hand Protection
  • Head Protection
  • Fall from Height protection
  • Protective Clothing/ Coveralls
  • Foot Protection
  • Hi Visibility Clothing
  • Other

• 

• Specify Hearing Protection Type/ Grade

  Select EN352 Disposable ear plugs EN352 Reusable ear plugs EN352 Over ear defenders EN352 Communication Ear defenders

  • EN352 Disposable ear plugs
  • EN352 Reusable ear plugs
  • EN352 Over ear defenders
  • EN352 Communication Ear defenders

• Task / Hazard Controlled

• 

• Specify Eye Protection Type/ Grade

  EN166 safety glasses - clear

  EN166 safety glasses - tinted

  EN166 safety goggles

  EN166/EN170 Face shield

• Task / Hazard Controlled

• 

• Specify Respiratory Protection Type/ Grade

  Select EN136 - face/dust mask EN136 - respirator - face fit required self contained breathing apparatus - training required

  • EN136 - face/dust mask
  • EN136 - respirator - face fit required
  • self contained breathing apparatus - training required

• Task / Hazard Controlled

• 

• Specify Hand Protection Type/ Grade

  Select EN388 Puncture resistant EN388 Cut resistant EN388 Impact resistant EN388 Abrasion resistant EN374 Chemical resistant EN407 Thermal (heat) resistant EN511 Thermal (cold) resistant EN388 Vibration resistant

  • EN388 Puncture resistant
  • EN388 Cut resistant
  • EN388 Impact resistant
  • EN388 Abrasion resistant
  • EN374 Chemical resistant
  • EN407 Thermal (heat) resistant
  • EN511 Thermal (cold) resistant
  • EN388 Vibration resistant

• Task / Hazard Controlled

• 

• Specify Protective coveralls/ clothing Type/ Grade

  Overalls

  Apron

  Knee/ Elbow pads

  Other

• Task / Hazard Controlled

• 

• Specify Head protection type

  EN812 Bump Cap

  EN397 Hard Hat

• Task/ Hazard controlled

• 

• Type/ grade of fall arrest equipment

  EN 361:2002 Safety harnesses

  EN795 Lifelines

  EN355 Lanyard

• Hazard/ Task controlled

• 

• Type/ grade of foot protection

  ISO 20345:2021 Safety Boot

  ISO 20345:2021 Safety Shoe

  Disposable shoe/boot covers

• Task/ hazard Controlled

• What other PPE type is required? (include grade and style)

• Task/ Hazard Controlled

• 

• Specify Type/Grade

  Select EN471,2 Hi Vis Vest front fastening

  • EN471,2 Hi Vis Vest front fastening

• Task / Hazard Controlled

First Aid

• Skin Contact

  Select Wash skin thoroughly with soap/water. Dry clean skin with waterless cleaner before washing with soap/water. If problems arise/persist, seek medical assistance.

  • Wash skin thoroughly with soap/water.
  • Dry clean skin with waterless cleaner before washing with soap/water.
  • If problems arise/persist, seek medical assistance.

• Ingestion

  Select Rinse Mouth Induce vomiting DO NOT Induce vomiting Keep head low to prevent vomit entering lungs/airways. Keep patient calm/still Observe patient for remainder of day, do not leave unattended. Seek immediate medical assistance. Take patient to fresh air. Loosen tight clothing including ties/belts Allow a quantity of drinking water.

  • Rinse Mouth
  • Induce vomiting
  • DO NOT Induce vomiting
  • Keep head low to prevent vomit entering lungs/airways.
  • Keep patient calm/still
  • Observe patient for remainder of day, do not leave unattended.
  • Seek immediate medical assistance.
  • Take patient to fresh air.
  • Loosen tight clothing including ties/belts
  • Allow a quantity of drinking water.

• Allow a volume of water to drink

  Select Upto 100ml Upto 500ml No limits

  • Upto 100ml
  • Upto 500ml
  • No limits

• Inhalation

  Select Remove into fresh air If respiratory irritation occurs, seek medical assistance Seek immediate medical assistance. Keep warm and rest. Do not give patient anything orally. Place in recovery position and wait for medical assistance. If breathing stops, apply mouth-to-mouth/assisted mechanical ventilation.

  • Remove into fresh air
  • If respiratory irritation occurs, seek medical assistance
  • Seek immediate medical assistance.
  • Keep warm and rest.
  • Do not give patient anything orally.
  • Place in recovery position and wait for medical assistance.
  • If breathing stops, apply mouth-to-mouth/assisted mechanical ventilation.

• If mouth-to-mouth is required ensure this is safe to do so, First Aider to be mindful of being affected themselves of the chemical product effecting the patient.

• Eyes

  Select Check for/Remove contact lenses Flush thoroughly with clean water for at least 15minutes Hold eyelids open occasionally (ensure clean hands). If irritation/vision issues occurs, seek medical assistance.

  • Check for/Remove contact lenses
  • Flush thoroughly with clean water for at least 15minutes Hold eyelids open occasionally (ensure clean hands).
  • If irritation/vision issues occurs, seek medical assistance.

Fire Fighting

• DO NOT ATTEMPT TO TACKLE A FIRE UNLESS TRAINED TO DO SO
  

• Fire Fighting Media

  Select H20 (Water) Powder CO2 (Carbon Dioxide) Foam

  • H20 (Water)
  • Powder
  • CO2 (Carbon Dioxide)
  • Foam

• Fire fighting considerations.

  Select Evacuate area Raise building alarms and evacuate facility Toxic fumes maybe produced. Smoke will effect visibility Dangerous by products maybe produced, e.g. acid from batteries! Risk of Explosion Keep upwind When extinguished, keep cool to prevent risk of re-ignition. Be aware of other chemicals and characteristics in affected area. Contact Emergency, Fire and Rescue (Fire Brigade) Prevent fire extinguisher run off entering drains/water courses.

  • Evacuate area
  • Raise building alarms and evacuate facility
  • Toxic fumes maybe produced.
  • Smoke will effect visibility
  • Dangerous by products maybe produced, e.g. acid from batteries!
  • Risk of Explosion
  • Keep upwind
  • When extinguished, keep cool to prevent risk of re-ignition.
  • Be aware of other chemicals and characteristics in affected area.
  • Contact Emergency, Fire and Rescue (Fire Brigade)
  • Prevent fire extinguisher run off entering drains/water courses.

Environmental Precautions

• Product should be stored and used in a manner with considerations that prevent the accidental release into drains and sewerage system together with other water courses, soaked into land and confined area. Be aware of vapours drifting into occupied and populated areas (on or off site).

General:

• What is the storage requirements?

  Select Above a specific temperature (Degrees) Not exceeding a specific temperature. (Degrees) In well ventilated area. In own packaging

  • Above a specific temperature (Degrees)
  • Not exceeding a specific temperature. (Degrees)
  • In well ventilated area.
  • In own packaging

• Enter maximum allowed storage temperature (Degrees).

• Is there adequate storage location for this material?

  Yes

  No

• What temperature should this material be stored at?

• Is an adequate temperature controlled area available?

  Yes

  No

Clean up Procedures / Accidental Release Measures:

• Environmental Spill Drills should be performed at least every 6 months and documented on Emergency Procedure Drill form.

• Clean up Procedures / Accidental Release Measures:

  Select Contain spillage using booms/socks Absorb spillage with non-combustible material (Provided in spill kits) If safe to do so, stop leak Use specific spill kit tools only and equipment, that don't spark Allow product to solidify, then remove. Label containers used to hold cleaned up spill material/media (Contact waste management company for suitable disposal). Use detergents to clean up remnants of spill. (Additional COSHH assessment required for this action) Consult with a clean up specialist.

  • Contain spillage using booms/socks
  • Absorb spillage with non-combustible material (Provided in spill kits)
  • If safe to do so, stop leak
  • Use specific spill kit tools only and equipment, that don't spark
  • Allow product to solidify, then remove.
  • Label containers used to hold cleaned up spill material/media (Contact waste management company for suitable disposal).
  • Use detergents to clean up remnants of spill. (Additional COSHH assessment required for this action)
  • Consult with a clean up specialist.

• Clothing/Work wear.

  Select Launder/Clean contaminated articles separately before re-use. Discard contaminated articles (In accordance with QSHE SOP 016 Waste Management)

  • Launder/Clean contaminated articles separately before re-use.
  • Discard contaminated articles (In accordance with QSHE SOP 016 Waste Management)

Risk Evaluation.

• Application Method

  Select With a brush/Mop Decanting using funnel/Manual pump Applying with cloth/Mixing Pump action Sprayer Via a pressurised gas canister/aerosol Other

  • With a brush/Mop
  • Decanting using funnel/Manual pump
  • Applying with cloth/Mixing
  • Pump action Sprayer
  • Via a pressurised gas canister/aerosol
  • Other

• Please specify application method

• Amount used

  Up to 100ml

  101ml - 1 Litre

  1-5 Litres

  5-10 Litres

  >10 Litres

• Exposure Time (Frequency)

  Annually

  Monthly

  Weekly

  Daily

  Hourly

• Exposure Time

  < 30 Minutes

  Up to 1 Hour

  1 -3 Hours

  3-6 Hours

  > 6 Hours

• Who is Exposed

  Select Operators/Contractors Colleagues Operators/Colleagues/Contractors Visitors General Public

  • Operators/Contractors
  • Colleagues
  • Operators/Colleagues/Contractors
  • Visitors
  • General Public

• Using the score from the risk evaluation, enter the appropriate "Task Hazard Level"

• Task Hazard Level

  Score 1 - 5 POTENTIAL

  Score 6 - 10 MINOR

  Score 11 - 15 MAJOR

  Score 16 - 25 SIGNIFICANT

Sign Off

• Assessor's Name and Signature

  Sign