HSE COSHH Assessment Template

• Client / Site

• Location
  Address

• Conducted on

  Date

• Prepared by

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

  Select Eye contact Inhalation Skin contact Ingestion Spill procedure

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

• What are the emergency procedures needed?

Methods of Prevention or Control of Exposure

• Engineering controls required

  Select Total containment Fume cupboard Local exhaust ventilation Blast screen Other

  • Total containment
  • Fume cupboard
  • Local exhaust ventilation
  • Blast screen
  • Other

• other engineering control needed

• Access control

  Select Restricted to competent personnel Special containment facility Other

  • Restricted to competent personnel
  • Special containment facility
  • Other

• other access control needed

• Special procedures

  Select SOP Code of Practice, local rules, etc Other

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

• other special procedure needed

• Approved PPE

  Select Gloves Eye protection Laboratory coat Other 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?

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

• 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

  Sign