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COSHH Form Template

This document contains a COSHH (Control of Substances Hazardous to Health) risk assessment form for substances used at the Astro House location. The form collects information on the substances used such as descriptions, quantities, hazards, and safety controls. It assesses risks from substances that are flammable, toxic, corrosive, or dangerous to the environment. The form outlines process information, required personal protective equipment like gloves and goggles, and emergency measures for spills, fires, and first aid. It identifies groups at risk and requires training. The assessment must be reviewed periodically.

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Phillipe Lys
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603 views2 pages

COSHH Form Template

This document contains a COSHH (Control of Substances Hazardous to Health) risk assessment form for substances used at the Astro House location. The form collects information on the substances used such as descriptions, quantities, hazards, and safety controls. It assesses risks from substances that are flammable, toxic, corrosive, or dangerous to the environment. The form outlines process information, required personal protective equipment like gloves and goggles, and emergency measures for spills, fires, and first aid. It identifies groups at risk and requires training. The assessment must be reviewed periodically.

Uploaded by

Phillipe Lys
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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ASTRO HOUSE

COSHH RISK ASSESSMENT FORM

Received: Due for Review:

Location: Ref Number:

Risk Assessment Title:


SUBSTANCE INFORMATION
Description of Procedure / Experiment Location / Room number
Extremely Flammable (F+) Highly Flammable (F)

Are any of these substances: (See warning label on packaging or MSDS)


Explosive (E) Oxidising (O) Very Toxic (T+) Toxic (T) Corrosive (C) Harmful (Xn) Irritant (Xi) Dangerous for Environment (N)

Are any of these substances hazardous to health:


When in contact with skin When in contact with eyes When breathed in When swallowed Carcinogen / Mutagen / Teratogen

Substance(s) Used

CAS Number (if exists)

Quantity

Products created and waste material

CAS Number (if exists)

Quantity

Chemical Reactions: Any material or chemical these substance(s) must not come into contact with?

PROCESS INFORMATION
Brief description of process and controls in place minimise risk

If any substance(s) are extremely flammable state lowest flash point

If appropriate, work only to be carried out by these named people

CONTROL MEASURES
Can less dangerous substances or processes be used? Do any substances used have Workplace Exposure Limits (WEL)? Substance

Yes / No Yes / No TWA (8 hours)

If so, why are they not being used? If so, give details below STEL (15 min)


Open Bench OK / None

Engineering Controls
Other: Local Exhaust Ventilation (LEV) Total enclosure/ Glove Box Fume Cupboard

Personal Protective Equipment (PPE)


Goggles / Facemask Protective clothing

Groups at risk
Other: Expectant Mothers

Students / Researchers

Visitors / Contractors

Respirator

Children

Gloves

Staff

Controls measures in place to minimise risk Additional info (e.g. type of gloves)

OTHER PRECAUTIONS AND EMERGENCY MEASURES

First Aid: What Action should be taken if substance(s) are: Swallowed:

How should an accidental release / spillage be dealt with?

In contact with Skin:

Fire Precautions: What actions will be taken in the event of a fire involving these substance(s)?

In contact with Eyes: Disposal: How should these substances be disposed of (or not disposed of)? Breathed in:

Is heath surveillance required?

Yes / No

Is training required for this process?

Yes / No

Sources of Information (e.g. Suppliers MSDS)

REASSESSMENT
Date for reassessment Review Date Reviewed By

DECLARATION
Assessment completed By: Supervisor: Departmental Safety Officer: Name: Name: Name: Signature: Signature: Signature: Date: Date: Date:

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