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    COSHH Assessment Form - Annexure 17

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    Balasubramaniamkamaraj
    This document contains a COSHH (Control of Substances Hazardous to Health) assessment form. It provides information on a chemical/substance including supplier details, hazards identified, first aid measures, likely routes of exposure, firefighting measures, required personal protective equipment, physical and chemical properties, stability and reactivity, toxicological information, ecological information, spill control methods, disposal methods, and transport information. The completed form is reviewed and signed off by an HSE advisor and task foreman to ensure proper handling and use of the assessed chemical/substance.

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    COSHH Assessment Form - Annexure 17

    Uploaded by

    Balasubramaniamkamaraj
    20 views2 pages
    This document contains a COSHH (Control of Substances Hazardous to Health) assessment form. It provides information on a chemical/substance including supplier details, hazards identified, first aid measures, likely routes of exposure, firefighting measures, required personal protective equipment, physical and chemical properties, stability and reactivity, toxicological information, ecological information, spill control methods, disposal methods, and transport information. The completed form is reviewed and signed off by an HSE advisor and task foreman to ensure proper handling and use of the assessed chemical/substance.

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    This document contains a COSHH (Control of Substances Hazardous to Health) assessment form. It provides information on a chemical/substance including supplier details, hazards identified, first aid measures, likely routes of exposure, firefighting measures, required personal protective equipment, physical and chemical properties, stability and reactivity, toxicological information, ecological information, spill control methods, disposal methods, and transport information. The completed form is reviewed and signed off by an HSE advisor and task foreman to ensure proper handling and use of the assessed chemical/substance.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    20 views2 pages

    COSHH Assessment Form - Annexure 17

    Uploaded by

    Balasubramaniamkamaraj
    This document contains a COSHH (Control of Substances Hazardous to Health) assessment form. It provides information on a chemical/substance including supplier details, hazards identified, first aid measures, likely routes of exposure, firefighting measures, required personal protective equipment, physical and chemical properties, stability and reactivity, toxicological information, ecological information, spill control methods, disposal methods, and transport information. The completed form is reviewed and signed off by an HSE advisor and task foreman to ensure proper handling and use of the assessed chemical/substance.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Doc no: EHS-L&T-F0

    COSHH ASSESSMENT FORM Issue No & date:

    CHEMICAL / SUBSTANCE PRODUCT NAME

    SUPPLIER DETAILS WITH CONTACT NUMBER

    RISK ASSOCIATED WITH USE

    SUMMARY of HAZARDS (Hazards identified on the container or safety data sheet) X ✓

    Compressed Flammable Oxidising Environmentally


    Explosive Corrosive Health Hazard Irritant Toxic
    Gas Gas Gases Hazardous
    E C    Xn T
    F O N
    FIRSTAID MEASURES / ACCIDENT RELEASE MEASURES

    Bring to fresh air area/ Get immediate medical


    Clean the area/Medical treatment  Immediate Medical attention attention 
    Eye wash 
    LIKELY ROUTE AND CAUSE OF EXPOSURE X ✓

    Eyes  Skin  Inhalation  Ingestion 


    FIRE FIGHTING MEASURES X ✓

    WATER  CO2  FOAM  DRY CHEMICAL POWDER 


    Safe for flammable liquids and Safe for wood, paper, textiles and Safe for wood, paper, textiles,
    Safe for wood, paper and textiles
    electrical fires flammable liquids flammable liquids and gaseous fires
    PERSONAL PROTECTIVE EQUIPMENT X ✓

          
    Face mask Chemical
    Safety shoes Hand glovers Face shield Respirator Safety goggles
    FFP2/FFP3 clothing/coverall

    STORING TEMPERATURE:
    PHYSICAL AND CHEMICAL PROPERTIES
    Physical Specific Volatile Auto
    Solid Content Solubility in
    State/Colour Viscosity Gravity Flash Point pH Organic ignition Others
    (% by wt) Water
    /Order (Kg /Lit) Compound temp

    Note: It is current safety policy that a written COSHH assessment must be provided when a substance to be used at site. Other hazards
    Page 1 of 2
    may also dictate the preparation of a suitable COSHH assessment.
    Doc no: EHS-L&T-F0
    COSHH ASSESSMENT FORM Issue No & date:

    STABILITY AND REACTIVITY


    Stability Condition to avoid Hazardous decomposition product Materials to avoid

    TOXICOLOGICAL INFORMATION

    HARMFUL
    HEALTH
    EFFECTS

    X ✓
    Eye splash / Irritants/Vision loss  Skin burn / Dermatitis  Cough/Bronchitis/Lung cancer  Stomach pain/ulcer/cancer 
    ECOLOGICAL INFORMATION

    SPILL CONTROL X ✓

    Drip trays 
    Spill kits  Impervious bund wall  Spill response plan 
    DISPOSAL METHODS

    TRANSPORT INFORMATION
    ROAD AND RAIL ( ADR/RID)  CARRIAGE BY SEA (IMCO)  TRANSPORT BY AIR (IATA)  PACKAGING 

    OTHER INFORMATION (IF ANY)

    Additional Comments (if any)


    TRAINING REQUIRED X ✓ 

    Additional Comments (if any)


    HEALTH MONITORING REQUIRED X ✓ 

    ASSESSMENT RESULTS
    (FURTHER CONTROLS IF ANY REQUIRED)

    PREPARED BY (RESPONSIBLE ENGINEER)


    Name: Signature: Date:

    ASSESSED BY (HSE ADVISOR)


    Name: Signature: Date:
    HANDED OVER TO (TASK FOREMAN)
    (For site implementation) Name: Signature: Date:

    Note: It is current safety policy that a written COSHH assessment must be provided when a substance to be used at site. Other hazards
    Page 2 of 2
    may also dictate the preparation of a suitable COSHH assessment.

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