COSHH Assessment Form

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COSHH RISK ASSESSMENT

SERIAL NO
PRODUCT NAME:

DEPARTMENT: Project Area:

Describe the activity


or work process.
(Inc. how long/ how often
this is carried out and
quantity substance used)
Identify the personsat risk: Employees Sub-contractors Public

Name the substance involved in the


process and its manufacturer.
(A copy of a current safety data sheet is
attached to this assessment)

Classification (state the category of danger)

Very Toxic Irritant- Extremely


dermatitis causing Flammable

Toxic Sensitising Highly


Flammable
Corrosive Biological Flammable

Harmful-lung Oxidising Environmental


damage if swallowed -aquatic organisms

Hazard Type

Gas Vapour Mist Fume Dust Liquid Solid Other (State)


Route of Exposure

Inhalation Skin Eyes Ingestion Other (State)


Workplace Exposure Limits (WELs) please indicate n/a where not applicable
Long-term exposure level Short-term exposure level

State the Risks to Health from Identified Hazards

Control Measures:

Risk / Safety Phrases


COSHH RISK ASSESSMENT

Is health surveillance or monitoring required?


Yes No
Personal Protective Equipment (state type and standard)

Dust mask Visor

Respirator Goggles

Gloves Overalls

Footwear Other
First Aid Measures
Inhalation:

Skin:

Eyes:.

Ingestion:

Storage
Storage:

Disposal of Substances & Contaminated Containers

Hazardous Waste Skip Return to Depot Return to Supplier Other

(If Other Please State):

Is exposure adequately controlled?


Yes No
Risk Rating Following Control Measures

High Medium Low

Assessed by: Date: Review Date:

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