OTIS RISK ASSESSMENT FORM Based on ISO 178 Risk Assessment

nd
NO: COSHH A04 DATE: Reviewed and updated 22 July 2010 [original NOTES: STORAGE and DISPOSAL FLASH POINT -42oC
th
13 July 2006]

SITE & LOCATION: The following details the COSHH assessment of the use of and exposure to 3M Adhesive 90
Methylene Chloride Free [XA-4441]. EMERGENCY CONTACT: 3M UKPLC , 3M Centre, Cain Rd, Bracknell,
Berks RG12 8HT Tel: - 01344 858000
EXTREMELY FLAMMABLE: - Store in NO SMOKING location, below 25 deg C in original
closed containers in a dry well ventilated place away from heat, sparks, direct sunlight and
other sources of ignition and oxidizing agents. Prevent entry into drains and watercourses.
Spills absorb onto inert absorbent material e.g. sand or earth. Do not puncture container.
Seek advice from EH&S Dept regarding disposal. In event of fire, use Class B extinguishing
agent [AFFF, dry chemical, CO2] Avoid inhaling vapour and contact with skin [see
below]. DO NOT EAT, DRINK or SMOKE when using product. TOXIC to aquatic
organisms.

Assessment carried out by: Richard Askew CMIOSH P = Persons at S = Severity F = Frequency/Probability
Risk

Signed: Negligible 1 Impossible 1 Probable 5

MAIN ACTIVITY/SITUATION: Employee E Minor Injury 2 Improbable 2 Frequent 6

Exposure during the application of 3M Spray Adhesive as an adhesive during fitting of floor Contractor C Serious Injury 3 Remote 3
covering in lifts. Spray application onto floor from 300ml container.
Creamy white liquid with mild solvent odour in an aerosol. Contains dimethyl etherpentane, Public P Major Injury 4 Occasional 4
acetone and cyclohexane. A high strength, fast drying, contact-type adhesive for
professional or industrial use.
No Activity/Location Hazards Identified - (Effect) P S F Risk Control Measures/Corrective Actions S F Risk Residual Risk
Materials/Tools etc
A0 Rating Identifying persons responsible where necessary. Rating
4 (Cause/Trigger)
(S x F) (S x F)
A Inhalation of vapours VAPOURS MAY CAUSE DROWSINESS and E 2 4 8 USE ONLY IN WELL VENTLATED AREA – use LEV 2 2 4 If signs / symptoms develope
/ aerosols DIZZINESS. Intential concentrations or inhalation C where necessary. Wear respiratory protection i.e. get medical attention.
may be harmful or fatal. Inhalation may affect P respirator with organic vapour filter. Beware vapours
Central Nervous System causing headaches, may travel long distances along floor. REMOVE
dizziness, drowsiness, in-coordination, nausea , PERSON TO FRESH AIR, KEEP WARM & REST
slurred speech etc.
B Adhesive entering May cause moderate irritation. E 2 3 6 Avoid eye contact with vapours, mists or spray. 2 1 2 If signs / symptoms persist
the eyes Engineer to wear eye protection when using – see get medical attention.
Company Safety Handbook. Flush eyes with large
amounts of clean water for at least fifteen minutes.
C Skin contact on May cause moderate irritation. Repeated E 3 5 15 AVOID SKIN CONTACT. Engineer to wear impervious 3 1 3 If signs / symptoms develope
hands / skin. exposure may cause dryness or cracking. gloves i.e. marigold blue nitrile / heavyweight nitrotough get medical attention.
Although not common sensitiser but repeated / polyethylene gloves – see Company Safety Handbook.
exposure may cause sensitisation or damage the Wash affected area with soap and water or proprietary
skin. May cause redness, swelling and itching. skin cleaner especially hands before eating and toilet.
Absorption through skin may affect Central Do not clean skin with white spirit.
Nervous System.

Risk Rating Key: 1 - 4 Low = Acceptable, 5 - 9 Medium = Investigate and where practical reduce the risk, 10 - 14 High = Action must be taken to reduce the risk,
15 - 24 Very High = RISK IS TOO HIGH TO START WORK OR CONTINUE. WORK MUST STOP

Form No. 78.9.09.004.05.00 Sheet No:_____ of _____

OTIS RISK ASSESSMENT FORM Based on ISO 178 Risk Assessment

D Adhesive being May cause irritation to digestive system. Ingestion E 4 2 8 DO NOT EAT, DRINK OR SMOKE when using 2 2 4 Accidental ingestion is
ingested unlikely but hazard of aspiration due to ingestion of product. Give two glasses of water if ingested and unlikely
subsequent vomit. conscious. DO NOT INDUCE VOMITING - GET
MEDICAL ATTENTION

Risk Rating Key: 1 - 4 Low = Acceptable, 5 - 9 Medium = Investigate and where practical reduce the risk, 10 - 14 High = Action must be taken to reduce the risk,
15 - 24 Very High = RISK IS TOO HIGH TO START WORK OR CONTINUE. WORK MUST STOP

Form No. 78.9.09.004.05.00 Sheet No:_____ of _____