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COSHH Assessment Form

1. This document is a COSHH (Control of Substances Hazardous to Health) assessment form used to evaluate potential hazards posed by chemical substances. 2. It collects information on the substance being assessed, number of employees exposed, hazards identified, and whether the substance is hazardous by inhalation, ingestion, or absorption. 3. The form also addresses existing controls, personal protective equipment requirements, workplace exposure limits, accident/spill response measures, disposal procedures, and firefighting measures.

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mohamed atef
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291 views

COSHH Assessment Form

1. This document is a COSHH (Control of Substances Hazardous to Health) assessment form used to evaluate potential hazards posed by chemical substances. 2. It collects information on the substance being assessed, number of employees exposed, hazards identified, and whether the substance is hazardous by inhalation, ingestion, or absorption. 3. The form also addresses existing controls, personal protective equipment requirements, workplace exposure limits, accident/spill response measures, disposal procedures, and firefighting measures.

Uploaded by

mohamed atef
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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COSHH Assessment Form

HSE-PRC-17024-F1

Substance: Assessment #:
Supplier: Emergency #:

No. Employees Involved: CAS #

How is it Used?

HAZARDS (delete/ add as appropriate)


Harmful to the
Corrosive Highly Toxic Toxic Harmful Flammable Explosive Other
Environment

HAZARD TYPE (delete/ add as appropriate)


Gas Vapour Mist Fume Dust Liquid Solid Other
Description: Yes/ No Notes (incl. Relevant Exposure Standards, Safety and Risk Phrases)
Hazardous by inhalation?
Hazardous by ingestion?
Hazardous by absorption?
Irritant to the eyes?
Irritant to the skin?
Harmful to the environment?
Observations on task and possible exposures (incl. Existing Controls (incl. Enclosures, Ventilation, SWI’s etc.):
Storage, Movement, Handling, Use, etc.):

Hazard Assessment (attach additional information as an appendix): N/A YES NO


1. Is manufacturers Safety Data Sheet (MSDS) available?
2. Has the ‘lowest hazard’ substance suitable for the task been selected?
3. Has specific training required for handling this substance been provided?
4. Is exposure monitoring required?
5. Are additional control measures required?
6. Are control measures routinely maintained, examined and tested?
7. Is health surveillance necessary?
8. Are Emergency Response Plans (first aid, fire, spill etc.) available and up to date?
9. Is appropriate storage and dispensing requirements for the substance provided?
10. Must an Authorised Waste Disposal Contractor dispose of the substance?
11. Are all necessary permitting requirements understood and in place?
Require Personal Protective Equipment (state type and standard).
Respirator Dust Mask

Safety Goggles Face Shield

Gloves Protective clothing

V 1.0 Issue Date: Page 1 of


COSHH Assessment Form
HSE-PRC-17024-F1

First Aid Measures

Inhalation

Skin Contact

Eye Contact

Ingestion
Workplace Exposure Limits (WEL)
Long term exposure limit (8hr TWA) Short term exposure limit (15 mins)

Accidental release control measures

Disposal arrangements

Fire Fighting Measures

Any further information:

Assessor
Name (print) Signature

Date SDS Review


Date

V 1.0 Issue Date: Page 2 of

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