COSHH Assessment

COSHH ASSESSMENT SHEETCompleted by: Date:Job description

Location on site

Activity or process

Hazardous substance used(Use one form for each substance)

Tick appropriate boxes

Yes No Yes No Yes No Yes No Yes No Yes No

Yes No Yes No Yes No Yes No

DESCRIPTION OF THE ACTIVITY (including all job steps)

HAZARDS FROM ACTIVITY (all hazards associated with the task should be entered here)

THOSE AT RISK OF EXPOSURE (staff, public and others)

CURRENT CONTROL MEASURES (list current control measures and observations on their use)

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WITH THESE CONTROLS THE RISK OF EXPOSURE IS (CIRCLE)

Unacceptable Further controls required

Adequately controlled

Need more information

FURTHER CONTROL MEASURES REQUIRED (list further action needed to adequately control exposure)

Review dateInitials

Hazardous substances (information on all hazardous substances associated with the task should be entered here):

Name,

strength, form

Data sheet Y/N

Hazard category e.g. toxic, risk phrase(s)

Route(s) of exposure

Effects of exposure

Work exposure limit

Ppm or mg/m3

8hrs or 15 mins


Summary of measures (List measures relating to storage, handling, disposal and emergency measures). Also list any monitoring of controls.

Name and signature of assessor: Date:

Name and signature of Head of Department: Date:

Name and signature of supervisor: Date:

SUBSTANCES INVOLVED

(with approximate quantities)

HAZARDS(E.g. from CHIP)

MEL/OES(from EH40)

ROUTES OF ENTRY

Are any: asthmagens? Yes No ; carcinogens? Yes No ; biological agents? Yes No

If yes, attach a description of how the COSHH additional requirements are being met.

Ionising radiation/laser/UV: Yes ; No ; If yes, specify:

Other hazards (describe):

Precautions:


PERSONS AT RISK (Who might be harmed and how?) Are new/ expectantmothers especially at risk?

Yes

No

EXISTING PRECAUTIONS (What controls are currently in place and are they adequate?)

Engineering measures (indicate if used)

Complete enclosure ; biological safety cabinet (specify containment level)

Fume cupboard ; other LEV ; general ventilation ; other (describe)

Procedural measures (indicate if used)

Written instructions/procedures ; Training ;

Health surveillance ; Air monitoring ; Fit-testing for RPE

Personal protective equipment (indicate if used)

Face & eyes: visor ; goggles ; spectacles Hands: ; Respiratory (RPE) ;

Other: (specify)

Specify grade, type etc:


Documents

COSHH Assessment