COSHH Assessment prepared by
Substance / material Enter the substance or material name or trade name here
Suppliers address and phone number
Enter the suppliers or manufacturers address and phone number here
Contents / ingredients of product Enter the chemicals and substances that are found in
the product. Note that these ingredients can be found
Is there a work
on the product data sheet which is produced by the
Yes ☐
exposure limit
manufacturer
Where the product’s used
How the products used
Product hazard levels
Check one of
the boxes to the
No ☐
Duration
left and enter
the time
duration here
Outside ☐
Inside well ventilated ☐
Inside poorly ventilated ☐
Confined space ☐
Mixing ☐
Pouring ☐
Spraying ☐
Brushing ☐
Applying by hand / hand tools ☐
Loading out ☐
High ☐
Medium ☐
Low ☐
Product state
Solid ☐
Liquid ☐
Gas ☐
__________________Check the relevant boxes above_________________
Flammable
Oxidising
Gas under
pressure
Explosive
Very toxic
Corrosive
Serious health
hazard
Health
hazard/irritant
Danger to
environment
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PPE
Outside
Inside well
ventilated
Inside poorly
ventilated
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Gloves
Glasses
Goggles
Face shield
Footwear
PPE Clothes
Dust mask
FFP2 mask
FFP3 mask
Respirator
Noise
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Confined
space
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Is the substance hazardous to health when: Check the relevant boxes below
Breathed in ☐
Swallowed ☐
In contact with skin ☐
In contact with eyes ☐ Other. Please specify
Health risks: Outline the health risks here
Inhalation: Create specific sub headings for specific risks and give details
Contact dermatitis/Sensitising effects: If the product can cause contact dermatitis, or sensitise the skin, give details here.
Medical conditions aggravated by exposure: If the product may agrivate existing medical conditions give details here.
Add Another sub heading here: As an example, another product may have a narcotic effect if vapours are inhaled.
Check the relevant boxes below
First aid and emergency measures:
Emergency servics
First aider
First aid box
Shower
Eye wash
Wash affected area
Boot wash
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First aid details:
After significant accidental inhalation: Type in what needs to be done if there has been significant accidental inhalation.
After contact with eyes: Type in what needs to be done if the product comes into contact with someone’s eyes.
After skin contact: Type in what needs to be done if the product comes into contact with someone’s skin.
After significant accidental ingestion: Type in what needs to be done if someone has ingested the product.
Spillage and environmental:
Type in the hazards the product may have to the environment, water courses, aquatic life etc… if there is an accidental spillage or release.
Mobility: Does the product pose ant hazards during transportation?
Accidental release: If there is an accidental release, how should the product be cleaned up?
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Water
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Carbon Dioxide
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Dry powder
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Check the relevant boxes
Foam
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Fire blanket
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Raise alarm
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Fire details:
Enter fire details of product and packaging
Document author:
Enter your name
Signed:
Either print and sign or enter a digital signature
Date:
Enter todays date
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