COSHH - Blank Risk Assessment Template
|[pic] |COSHH Risk Assessment No: XXXXX |INSERT LOGO |
| |Product Name: xxxxx | |
|Company name: |Dept. (if applicable): |
|Describe the activity or work | |
|process. | |
|(Inc. how long/ how often this is | |
|carried out and quantity substance | |
|used) | |
|Location of process being carried | |
|out? | |
|Identify the persons at risk: |Employees |Sub-contractors |Public |
|Name the substance involved in the process and its | |
|manufacturer. | |
|(A copy of a current safety data sheet is attached to | |
|this assessment) | |
| | |
|Classification (state the category of danger) |
|[pic] | |[pic] | |[pic] | |
| |Toxic | |Oxidising | |Gas Under Pressure |
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| |Harmful/ Irritant | |Flammable | |Carcinogen |
|[pic] | |[pic] | |[pic] | |
| |Corrosive | |Explosives | |Dangerous for |
| | | | | |the environment |
|Hazard Type |
| |
| |
| |
|Gas Vapour Mist Fume Dust Liquid Solid Other (State) |
|Route of Exposure |
| |
| |
|Inhalation Skin Eyes Ingestion Other (State) |
|Workplace Exposure Limits (WELs) please indicate n/a where not applicable |
| | |
|State the Risks to Health from Identified Hazards |
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|Control Measures: |
| |
|Is health surveillance or monitoring required? |
|Yes No |
|Personal Protective Equipment (state type and standard) |
| | | | |
| | | |Suitable for chemical splashes |
| | | | |
|Dust mask | |Visor | |
| | | | |
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| | | | |
|Respirator | |Goggles | |
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|Gloves | |Overalls | |
| | | | |
| | | | |
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|Footwear | |Other | |
|First Aid Measures |
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|Storage |
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|Disposal of Substances & Contaminated Containers |
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|Hazardous Waste Skip Return to Depot Return to Supplier Other |
| |
|(If Other Please State): |
| |
|Is exposure adequately controlled? | |
| |Yes No |
|Risk Rating Following Control Measures |
| |
|High Medium Low |
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Assessed by: xxxx Date: xxxx Review Date: xxxx
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