41. SNOC-MCT-HSE-COSHH Assessment Form

COSHH ASSESSMENT
Company: Assessment Date:

Material Safe Use For Products Classified as Hazardous
Process / Task / Activity Title:
Complete one form for each product and one form for each change in the process/task/activity
Product classified as
Hazardous:
 Yes  No
Is product Hazardous to the
environment:
 Yes  No (If used correctly)
Name of product:
UN Number:
Supplier or Manufacturer:
Quantity held on-site:
Storage requirements:
Warning signage required:
MSDS supplied and available:  Yes (if not do not proceed)

MSDS less than 5 years old:  Yes (if not do not proceed)
Fire Extinguisher Required :
 No Yes -  Powder  CO2  Water
Can a less hazardous product be used in substitution?  Yes  No (if yes do not proceed, investigate substitution)
Can this product be used safely by just following the  Yes  No (if No follow the WMS listed at the bottom of the
MSDS for guidance? next page including all precautions listed here.)
 Inhalation or suffocation  Swallowed or ingested

Hazards that this product
presents:
 Skin absorption  Environmental
 Contact with eyes  Fire or explosion
Material Safe Use Task Resources (how the product is used)
Personnel Involved Equipment Used Other Materials Used
Identify applicable hazard controls for Material Safe Use

What controls are used to eliminate or reduce the risk that the
Hazards identified
hazard presents
SNOC-MCT-HSE-COSHH Assessment Form 1

COSHH ASSESSMENT
 Appropriate filter mask PPE

 Well naturally ventilated area
Inhalation  Forced ventilation or extraction
 Positive pressure self-contained
breathing apparatuses
 Appropriate impervious gloves  Barrier creams
Skin absorption  Coveralls, long sleeves, trousers 
 Glasses  Face shields
Contact with eyes  Goggles  Splash guards
 Washing facilities available  No smoking permitted
Swallowed or ingested  Gloves  Decant product into approved container
 Drains covered  Dust/Fume containment
Environmental  Spill kit available 
 Fire extinguisher  Fire blanket
Fire or Explosion  Sources of ignition removed  No smoking
Material Safe Use Training

What training is required to undertake the process safely in order
Element
to eliminate or reduce the risk that the hazard presents
 Selection  Licences required
Equipment  Use  Set-up or establishment
 Selection  Licences required
Plant  Use  Set-up or establishment
Personal Protective  Selection  Replacement
Equipment  Use 
 Mixing instructions  Ventilation set up
Product use or preparation  Precautions required 
 Set-up  Equipment considerations
Environmental controls  Use of spill kit 
* Refer to the Toolbox talk form for the close out of required training as listed above.
Material Safe Use Special Precautions
Element What special precautions need to be in-place
 Eye shower  Burn kit
First Aid  Whole body shower  General First aid kit
 Portable fire fighting appliance  Brigade required (emergency)
Fire Fighting  Fire hose reel  Isolation of detectors
 Permits required (Hot work)  Spotters
 Shut down mechanical ventilation  Permits required
Ventilation intake systems  Discharge location clear
 Members of the Public considered  Non explosive extraction fans
 Isolation barricading  Clean-up at completion
Product use  Display of signage  Wash before meals
 Permits required  Clean-up at completion
Environmental controls  Waste disposal considered 
International symbols to aid in the safe use of the product.
Warnings associated with this product (if applicable)
 Yes  Yes  Yes  Yes  Yes  Yes  Yes  Yes

COSHH ASSESSMENT
PPE required with this product (if applicable)
Nitrite Impervious Normal Gloves Protective Suit Rubber Boots Goggles
 Yes  Yes  Yes  Yes  Yes
Full Face Shield Welding Shield Dust Mask Vapour Mask Breathing Apparatus

Controls associated with this product (if applicable)


Assessed By: Verified By:
Signature: Signature:
Date: Date:

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COSHH ASSESSMENT

Company: Assessment Date:

Process / Task / Activity Title:

Quantity held on-site:

Warning signage required:

MSDS supplied and available:  Yes (if not do not proceed)

 Inhalation or suffocation  Swallowed or ingested

Material Safe Use Task Resources (how the product is used)

Personnel Involved Equipment Used Other Materials Used

Identify applicable hazard controls for Material Safe Use

SNOC-MCT-HSE-COSHH Assessment Form 1

 Appropriate filter mask PPE

Material Safe Use Training

International symbols to aid in the safe use of the product.

Warnings associated with this product (if applicable)

 Yes  Yes  Yes  Yes  Yes  Yes  Yes  Yes

SNOC-MCT-HSE-COSHH Assessment Form 2

PPE required with this product (if applicable)

Nitrite Impervious Normal Gloves Protective Suit Rubber Boots Goggles

 Yes  Yes  Yes  Yes  Yes

 Yes  Yes  Yes  Yes  Yes

 Yes  Yes  Yes  Yes  Yes

 Yes  Yes  Yes  Yes  Yes

SNOC-MCT-HSE-COSHH Assessment Form 3

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