COSHH RISK ASSESSMENT FORM

Substance / Trade Name (Name the substance involved in the process and its manufacturer)

Safety Data Sheet Provided Yes No

Quantities Used

Value

Persons at Risk Employees Contractors Public

Other (state who)

Workplace Exposure Limits (WELs) Long-term exposure level (8hrTWA)

Short-term exposure level (15mins)

Approved Uses

Risks to Health - HAZARDS - Prior to July 2015, hazards were symbolised by the following images:

Toxic / Dangerous for Highly Extremely

Corrosive Harmful Carcinogenic Irritant Oxidising Flammable
Very Toxic the Environment Flammable Flammable

As of July 2015, hazards are symbolised by the following images:

Serious Health Hazardous for the Gas Under
Corrosive Acute Toxicity Health Hazard Oxidising Flammable
Hazard Environment Pressure

Hazard Type Gas Vapour Mist

Fume Dust Liquid
Solid Other (state)

Route of Exposure Eyes Skin Ingestion

Inhalation Other (state)

Risks to Health
from Identified
Hazards

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Recommended Control Measures Ensure cuts are covered Avoid contact with eyes Ventilation
Training Supervision Extraction

Other (Please state)

E.g. Use gloves to avoid prolonged or
repeated skin contact. Avoid breathing in
vapours or dust. Do not drink or smoke
whilst using this product.

Include special measures for vulnerable groups,

such as disabled people and pregnant workers.

Is Health Surveilance Monitoring in Place? Yes No

Protective Equipment to be Worn

Specific Proective Equipment to be Worn

First Aid – ALWAYS REMOVE PERSON FROM SOURCE OF CONTAMINATION

First Aiders

First Aid Kit Located at…

Emergency Contact Information

Storage Requirements / Disposal Requirements

Spillage Management

Is Exposure Adequately Controlled? Yes No

Risk Rating Following Control Measures Low Medium High
Further Action Required? Yes No

Detail Action Required

Action Required By Who?

Action Required By When?

All Actions to be Completed By?

Completed By: Date: Review Date:

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