Reference Number:
COSHH Risk Assessment Form
Assessment Date:
Department:
Room/Location:
Name of Substance(s):
Physical Form (S9):
Review Date:
Choose an item.
Describe the activity / work process:
Exposure Time:
Persons at risk:
Employees
Members of public
Cleaners
Contractors
Students
New & expectant Mothers
Hazard Classification (S2-3)
Very Toxic
Irritant
Extremely
Flammable
Toxic
Sensitising
Highly
Flammable
Corrosive
Biological
Flammable
Harmful
Dustiness (S9):
Small Medium
Large
(g/ml) (kg/litres) (tonnes/cu.m)
Low
Medium
High
Not Classified
Environmental
Oxidising
Quantity:
Other:
Carcinogenic
Volatility (S9):
Route of Entry (S11):
Low Medium High
Inhalation
Absorption Ingestion
(Skin Contact)
Workplace Exposure Limits (WELs) please indicate n/a where not applicable (S8)
Long-term exposure level (8hrTWA):
Short-term exposure level (15 mins):
mg/m3
mg/m3
Risk Rating Before Control (tick box)
A:Tolerable 0-19
B: Moderate 20-39
M:Microorganisms
C: Substantial – 40-79
D:Intolerable – 80-100
IR: Ionizing Radiation
Can a less hazardous substance be used to do the same job ?
(The supplier may hold this information)
Yes
No
Flammable Atmospheres (S2-3) - If identified as flammable list additional controls from DSEAR work sheet.
Choose an item.
Interactions with other substances (S10):
COSHHRA.V1.2010
Control Measures
Select control and specify details below as required:
Choose an item. • Choose an item. • Choose an item. • Choose an item. • Choose an item. •
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Detail Controls:
Personal Protective Equipment required when using the substance (state type and standard) (S8)
Dust mask
Visor
Footwear
Respirator
Goggles
Other
Gloves
Overall/Lab Coat
Health surveillance and / or monitoring required?
If yes please detail:
Yes
No
First Aid and Emergency Actions (S4, 5, 6)
General Advice:
If Inhaled:
Skin Contact:
Eye Contact:
If Swallowed:
Emergency Action:
RPE
Do not let enter drains
Spillage kit
Other
Storage (S7)
Flammable cabinet
Poison cabinet
Open Bench
Cold storage
Other
Disposal (S13)
Hazardous Waste
Skip
Return to Depot
Return to Supplier
Other
(If Other Please State):
Risk Rating After Control (tick box)
A: Tolerable
0-19
M:Microorganisms
B: Moderate
20-39
Is exposure adequately controlled?
C: Substantial
40-79
IR: Ionizing Radiation
Yes
No
Assessor Name:
Assessors Signature:
Date:
Safety Manager Name:
Safety Manager Signature:
Date:
COSHHRA.V1.2010
D: Intolerable
80-100