COSHH ASSESSMENT SHEET

Completed by: Job description Location on site Activity or process Hazardous substance used (Use one form for each substance) Tick appropriate boxes Date:

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)

Copyright 2012 Agora Business Publications LLP. This material may only be used in the furtherance of the subscriber's business and may not be sold, hired, copied or used for any other commercial purpose etc. without the prior written consent of Agora Business Publications LLP. Every effort has been made by Agora Business Publications LLP to ensure that the information given is accurate and not misleading, but Agora Business Publications LLP cannot accept responsibility for any loss or liability perceived to have arisen from the use of any such information.

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 date Initials Hazardous substances (information on all hazardous substances associated with the task should be entered here): Name, Data Hazard Route(s) of Effects of Work exposure sheet category e.g. exposure exposure limit strength, form Y/N toxic, risk Ppm or mg/m3 phrase(s) 8hrs or 15 mins

Copyright 2012 Agora Business Publications LLP. This material may only be used in the furtherance of the subscriber's business and may not be sold, hired, copied or used for any other commercial purpose etc. without the prior written consent of Agora Business Publications LLP. Every effort has been made by Agora Business Publications LLP to ensure that the information given is accurate and not misleading, but Agora Business Publications LLP cannot accept responsibility for any loss or liability perceived to have arisen from the use of any such information.

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

Name and signature of assessor: Name and signature of Head of Department: Name and signature of supervisor:

Date: Date: 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 Other hazards (describe): ; No ; If yes, specify:

Copyright 2012 Agora Business Publications LLP. This material may only be used in the furtherance of the subscriber's business and may not be sold, hired, copied or used for any other commercial purpose etc. without the prior written consent of Agora Business Publications LLP. Every effort has been made by Agora Business Publications LLP to ensure that the information given is accurate and not misleading, but Agora Business Publications LLP cannot accept responsibility for any loss or liability perceived to have arisen from the use of any such information.

Precautions:

PERSONS AT RISK (Who might be harmed and how?)

Are new/ expectant mothers especially at risk?

Yes No

EXISTING PRECAUTIONS (What controls are currently in place and are they adequate?) Engineering measures (indicate if used)

Complete enclosure Fume cupboard

; biological safety cabinet (specify containment level)

; general ventilation ; other (describe)

; other LEV

Procedural measures (indicate if used)

Written instructions/procedures Health surveillance Face & eyes: visor Other: (specify) ;

Training

Air monitoring ; spectacles

; Fit-testing for RPE Hands: ; Respiratory (RPE) ;

Personal protective equipment (indicate if used)

; goggles

Specify grade, type etc:

Copyright 2012 Agora Business Publications LLP. This material may only be used in the furtherance of the subscriber's business and may not be sold, hired, copied or used for any other commercial purpose etc. without the prior written consent of Agora Business Publications LLP. Every effort has been made by Agora Business Publications LLP to ensure that the information given is accurate and not misleading, but Agora Business Publications LLP cannot accept responsibility for any loss or liability perceived to have arisen from the use of any such information.