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HSE COSHH Assessment Template

HSE COSHH Assessment Template

Audit

Hazard Identification

Click + to add hazards identified
Note: *If the substance has a R45 or R49 risk phrase or a H350 or H350i hazard statement, it must also be registered on your personal carcinogen return (at Occupational Health) where exposure is not adequately controlled.

Substance

Name of Chemical

What will the chemical be used for?

Who may be exposed?

Hazardous Properties (Provide details of how the substance could cause harm, e.g. harmful by inhalation, skin contact, flammable, carcinogen, allergen, etc)

Quantity (Indicate how much of the substance will be used)

Workplace Exposure Limits (WELs)

Emergency procedures
  • Eye contact
  • Inhalation
  • Skin contact
  • Ingestion
  • Spill procedure

What are the emergency procedures needed?

Methods of Prevention or Control of Exposure
Engineering controls required
  • Total containment
  • Fume cupboard
  • Local exhaust ventilation
  • Blast screen
  • Other

other engineering control needed

Access control
  • Restricted to competent personnel
  • Special containment facility
  • Other

other access control needed

Special procedures
  • SOP
  • Code of Practice, local rules, etc
  • Other

other special procedure needed

Approved PPE
  • Gloves
  • Eye protection
  • Laboratory coat
  • Other PPE

Other approved PPE used

Disposal Procedures Note: (Give details of waste disposal procedure to be used)

Are chemicals with risk phrases R50-R59 or hazard statements H400 – H413 (environmental hazards) involved?

Training Requirements Note: (List any specialised training requirements before work can begin)

Handling and Storage Requirements (Note any special requirements e.g. ventilation, chemical incompatibility, flash point, etc)

Assessment of Risk Using Controls Detailed Above

Are the hazards/risks suitably controlled, using the control measures detailed above?

state the further actions required, e.g. Requirement for a standard operating procedure (SOP), etc

Authorization by Employer/Supervisor

I confirm that I have considered and understand the chemical to be used and the associated hazards. I am satisfied that all of the hazards have been identified and that the control measures to be followed will reduce the risks to as low a level as reasonably practicable.

Full Name and Signature of Inspector

HSE COSHH Assessment Template Checklist

Created by: SafetyCulture Staff | Industry: General | Downloads: 156

This COSHH assessment template was based from the Health and Safety Executive (HSE) and was converted using iAuditor. Start by listing chemical hazards and substances present in the workplace. Provide details of their usage and the people who may be exposed. Next record information on how the substance could cause harm and how much of the substance will be used for the job. Record Workplace Exposure Limits (WELs) and emergency procedures set by the management. Next, complete the information about the methods of prevention or control of exposure. Lastly, provide an overall rating of the assessment and affix a digital signature to validate the audit.

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HSE COSHH Assessment Template Checklist

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SafetyCulture Staff Downloads 156
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General
HSE COSHH Assessment Template
HSE COSHH Assessment Template

This COSHH assessment template was based from the Health and Safety Executive (HSE) and was converted using iAuditor. Start by listing chemical hazards and substances present in the workplace. Provide details of their usage and the people who may be exposed. Next record information on how the substance could cause harm and how much of the substance will be used for the job. Record Workplace Exposure Limits (WELs) and emergency procedures set by the management. Next, complete the information about the methods of prevention or control of exposure. Lastly, provide an overall rating of the assessment and affix a digital signature to validate the audit.

Audit

Hazard Identification

Click + to add hazards identified
Note: *If the substance has a R45 or R49 risk phrase or a H350 or H350i hazard statement, it must also be registered on your personal carcinogen return (at Occupational Health) where exposure is not adequately controlled.

Substance

Name of Chemical

What will the chemical be used for?

Who may be exposed?

Hazardous Properties (Provide details of how the substance could cause harm, e.g. harmful by inhalation, skin contact, flammable, carcinogen, allergen, etc)

Quantity (Indicate how much of the substance will be used)

Workplace Exposure Limits (WELs)

Emergency procedures
  • Eye contact
  • Inhalation
  • Skin contact
  • Ingestion
  • Spill procedure

What are the emergency procedures needed?

Methods of Prevention or Control of Exposure
Engineering controls required
  • Total containment
  • Fume cupboard
  • Local exhaust ventilation
  • Blast screen
  • Other

other engineering control needed

Access control
  • Restricted to competent personnel
  • Special containment facility
  • Other

other access control needed

Special procedures
  • SOP
  • Code of Practice, local rules, etc
  • Other

other special procedure needed

Approved PPE
  • Gloves
  • Eye protection
  • Laboratory coat
  • Other PPE

Other approved PPE used

Disposal Procedures Note: (Give details of waste disposal procedure to be used)

Are chemicals with risk phrases R50-R59 or hazard statements H400 – H413 (environmental hazards) involved?

Training Requirements Note: (List any specialised training requirements before work can begin)

Handling and Storage Requirements (Note any special requirements e.g. ventilation, chemical incompatibility, flash point, etc)

Assessment of Risk Using Controls Detailed Above

Are the hazards/risks suitably controlled, using the control measures detailed above?

state the further actions required, e.g. Requirement for a standard operating procedure (SOP), etc

Authorization by Employer/Supervisor

I confirm that I have considered and understand the chemical to be used and the associated hazards. I am satisfied that all of the hazards have been identified and that the control measures to be followed will reduce the risks to as low a level as reasonably practicable.

Full Name and Signature of Inspector

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