School of Design
Faculty of Performance, Visual Arts
and Communications
COSHH assessment
Assessment carried out by
Date
Reference number
AN ASSESSMENT OF HEALTH RISKS ASSOCIATED
WITH A PROCEDURE USING SUBSTANCES HAZARDOUS TO HEALTH
This document fulfils the requirements of the COSHH Regulations relating to a written risk
assessment. A written assessment is necessary unless the procedure is a very simple
one that is clearly understood by all persons involved and which can be repeated at any
time. It is not mandatory for this form to be used if the format is deemed to be restrictive.
Nevertheless, a suitable and sufficient risk assessment must be made before the
procedure is put in hand. Copies of the authorised assessment are to be retained by the
research worker(s) and must be available for inspection at all times.
All COSHH forms must be signed off by your supervisor or PI.
A copy of this form must be given to the School Safety Supervisor to be kept for our
records before the work starts or purchase of required chemicals is undertaken.
Assessors should be guided by the following publications from the Health and
Safety Executive:
 ‘COSHH Assessments: A Step by Step Guide’, HMSO 1988;
 ‘COSHH: Guidance for Universities, Polytechnics and Colleges of Further and Higher
Education’, HMSO 1990;
 ‘EH40/98: Occupational Exposure Limits 1998’, HMSO 1998;
 Manufacturers Safety Data Sheets (MSDS) for all stock and many non-stock items are
available on the internet.
Title of Experiment or Procedure
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Description of Procedure or Experiment
(give a literature reference if applicable and provide details of substances to be used overleaf)
Risk Assessment and Control Measures to be used
(continue on a separate sheet if necessary)
Required Checks of control measures before and during procedure
Fume cupboard required
Amount
YES/NO
Personal safety equipment required
Substance
Associated Hazards
(Toxic/Irritant/Carcinogenic/
Harmful/Corrosive etc.)
YES/NO
References
MSDS
consulted
?
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Can any less hazardous substance be used in place of any of the above?
YES*/NO
*If yes explain why it is not being used
Is the procedure being carried out authorised outside normal working hours?
YES*/NO
*If yes you must ensure
: - that your supervisor and Head of Department have given you written permission to do so
: - that another worker is close by during the experimental procedure.
What method of storage is needed for the chemicals?
Spillage control measures to be used?
Disposal measures (samples and waste):
Please indicate waste route
 Non-chlorinated Waste solvent  Chlorinated Waste solvent  Other, please specify:
Emergency Procedures (emphasise any special hazards)
Shutdown Procedures

Action in the event of fire
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
Action in the event of spillage or uncontrolled release

Treatment for personnel in the event of contamination, exposure to fumes or other
adverse effects
IF THERE IS A MEDICAL PROBLEM SEEK A FIRST AIDER.
YOU MUST INFORM THE SAFETY SUPERVISOR IF THERE IS AN ACCIDENT.
FOR SERIOUS PROBLEMS CALL SECURITY ON EXT 32222 OR (0113 3432222 ).
Name of Responsible Person, must
be either the Academic, PI or
Manager in charge:
Signature:
Date:
Users name:
Signature:
Date:
Approved by:
Signature:
Date:
IT IS YOUR (USERS) RESPONSIBILITY TO ENSURE THAT A COPY OF THIS FORM IS
ACCESSIBLE WHERE YOU ARE WORKING AND
YOUR SUPERVISOR’S RESPONSIBILITY TO RETAIN A COPY FOR DEPARTMENTAL
RECORDS
Continue on another sheet if necessary.
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