COSHH Assessment Template Document Number

This assessment only addresses the risk of harm to health from the substances listed. Additional risk assessments may be required to
control the risk from other hazards associated with these work/the procedures used. The task/process should be re-assessed on a regular
basis either annually, or if there are significant changes to the task or process or if there is a significant change in personnel who carry it out
it e.g., young/inexperienced workers, pregnancy, workers with pre-existing conditions such as asthma, dermatitis, etc.
COSHH ASSESSMENT SHEET

Name of Substance

Supplied by

Date of Assessment

What is the substance to be used for

Department

Site and Location of Substance

Workplace exposure limit specified □ Yes □ No

Who are at Risk

□ Staff □ Public □ Visitors □ Pregnant Workers □ Contractors

Route of Entry

□ Inhalation □ Absorption □ Ingestion

Exposure Limits

Occupational Exposure Maximum Exposure Workplace Exposure Limits

Hazard & Precautionary Statements:
Standard (OES): Limits (MEL): (WEL):

PPE Identification

Personal
Protective
Equipment (Tick
Required Boxes Hand Protective Protective
Safety Glasses Face Shield Face Mask Respirator
Protection clothing Footwear
□ □ □ □ □ □ □
Substance Properties (Tick all that apply)

Dangerous
Human Gas under
Harmful for
Oxidizing Explosive Flammable Toxic Corrosive Health pressure
environment
□ □ □ □ □ □ □ □ □

Prepared by: Engr. Mohsin www.hsefiles.com

 COSHH Assessment Template Document Number

Hazard Type

□ Gas □ Vapor □ Smoke □ Mist □ Dust □ Fume □ Solid □ Liquid □ Other

Control Measures

General Precautions First Aid Measures

Spillage Procedure Fire and Explosion Prevention

Handling and Storage Disposal Considerations

Assessor Checklist YES/NO Further Action

Has the assessment considered all factors pertinent to the use of the
substance? If NO, please give details of further action required.
Has the assessment considered the practicability of preventing exposure? If
NO, please give details of further action required.
Has the assessment considered the steps to be taken to achieve and
maintain adequate control of exposure where prevention is not reasonably
practicable? If NO, please give details of further action required.
Has the assessment considered the need for monitoring exposure to the
substance? If NO, please give details of further action required.
Has the assessment identified all action required to comply with
regulations? If NO, please give details of further action required.

COSHH Assessment

The task is safe to be carried out with The task is safe to be carried out subject to Task/substance is unsafe, significant non-
current control procedures. actions listed. compliance with health & safety standards.

□ □ □
Prepared By

Name: Designation: Signature:

Approved By

Name: Designation: Signature:

Prepared by: Engr. Mohsin www.hsefiles.com