HSE COSHH Assessment Template Checklist

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.

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

Methods of Prevention or Control of Exposure

Engineering controls required

Total containment
Fume cupboard
Local exhaust ventilation
Blast screen
Other

Access control

Restricted to competent personnel
Special containment facility
Other

Special procedures

SOP
Code of Practice, local rules, etc
Other

Approved PPE

Gloves
Eye protection
Laboratory coat
Other PPE

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?

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: 20

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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Audit

Hazard Identification

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