3/11/2020
COSHH Risk Assessment Form Checklist - SafetyCulture
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Audit
General Information
Department
Enter text
Persons involved in COSHH Assessment
Enter text
People at Risk
Employees
Students
Vulnerable persons
Others
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COSHH Risk Assessment Form Checklist - SafetyCulture
Hazard Identi cation
Add + activity or work process
Process
Enter text
How long will it take?
Enter text
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How often will it be repeated?
Enter text
How much substance is used?
Enter text
Locaton of the process or work being carried out
Enter text
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Hazard
Acute Toxicity
Very Toxic (fatal)
Serious eye irritation
Oxidising
Corrosive
Respiratory Sensitiser
Flammable
Dangerous to the environment
Highly Flammable
Harmful
Explosive
Serious long term health hazard
Extremely Flammable
Gasses under pressure
Indicate below which form the substance takes
Gas
Vapor
Mist
Fume
Dust
Liquid
Soild
Other state/form
Indicate below which route(s) of exposure the substance takes
Inhalation
Skin
Eyes
Ingestion
Other state
Workplace Exposure Limits (WELs)
Long-term exposure level
Enter text
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Short-term exposure level
Enter text
List the risks to health below from exposure to the substance
Enter text
Control Measures
List below control measures eg extraction, ventilation, supervision, include
additonal controls for vulnerable persons where necessary
Enter text
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Is health surveillance or monitoring required? (remember health surveillance may
be required for vulnerable persons eg pregnant/young workers those with
asthma, dermatitis etc)
Yes
No
N/A
Personal Protective Equipment
Identify type and speci cation
Dust mask
Overalls
Respirator
Gloves
Footwear
Visor
Goggles
Other
Provide standard measures for each PPE required
Enter text
First Aid Measures
Write rst measures when in contact with these chemicals
Enter text
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Storage and Disposal of Substances and Contaminated Containers
How do you store these substances?
Enter text
Means of Disposing Hazardous Waste
Skip
Return to Depot
Return to Supplier
Other
Summary
Is the exposure adequately controlled?
Yes
No
N/A
Risk rating after following control measures
HIGH
MEDIUM
LOW
Completion
Full Name and Signature of the Inspector

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