Environment Department CoSHH Assessment Form
LOCATION AND PERSONNEL
Department:
Location of work:
Personnel involved:
Title of Proposed work:
See http://www.york.ac.uk/environment/safety/coshh for more information
UNIVERSITY HAZARD SEVERITY LEVEL
Hazard code *
(tick appropriate box(es))
Substances used/formed during
Approximate quantities to be
1
2
3
4
experiment
used/made (include units)
* see Appendix 1 for code details
GENERAL HANDLING CONTROL MEASURES
Using the categories detailed within Appendix 1 detail the control measures to be adopted:
EMERGENCY HANDLING CONTROL MEASURES
Using the categories detailed within Appendix 1 detail the emergency actions to be adopted:
ADDITIONAL INFORMATION
Any other information not covered by COSHH e.g. flammability, heat, cold, noise, pressure:
PAGE 1 ASSESSMENT AND REVIEW
ASSESSED BY:__________________________
REVIEWED BY: ________________________
SIGNED:______________DATE:___________
SIGNED:______________DATE:___________
NB This document must contain all 5 pages to be valid in order that coded control measures can be
cross-referenced in an emergency.
This document can only be completed by referencing a current material data safety sheet (MSDS)
Page 1 of 5
PROCEDURE
Give details of the proposed procedure:
DISPOSAL AND STORAGE PROCEDURES
Give details of the proposed disposal and storage procedures, including storage conditions and
approximate expiry times of samples/reagents prepared:
PAGE 2 ASSESSMENT AND REVIEW
ASSESSED BY:__________________________
REVIEWED BY: ________________________
SIGNED:______________DATE:___________
SIGNED:______________DATE:___________
Page 2 of 5
Appendix 1
General Handling Control Categories
CATEGORY
Main
Division
1
PROCEDURE
a
b
c
d
e
GLOVES
Disposable Nitrile
Disposable Latex
Rubber
Heatproof
Specific type for task (see assessment giving details)
a
b
c
d
e
f
PROTECTIVE CLOTHING
Laboratory coat or equivalent
Disposable overalls
Oversleeves
Overshoes
Plastic apron
Protective footwear (give details)
a
b
c
EYE/FACE PROTECTION
Safety glasses
Face shield
Safety Goggles
2
3
4
a
b
c
5
a
b
c
ENGINEERING CONTROLS
Open bench in ventilated area
Fume cupboard
Laminar flow cabinet
RESPIRATORY PROTECTIVE EQUIPMENT
Disposable filtering facemask
i – organic vapour
ii – dust
iii – combination organic vapour/dust
MUST SPECIFIY TYPE
Powdered respirators/helmets with safety visor
Self contained breathing apparatus SCBA
6
7
SPECIFIC IMMUNISATION REQUIRED (Give details)
8
9
REFER TO MATERIAL SAFETY DATA SHEET (for additional information)
KNOWN OR SUSPECTED REPORDUCTIVE HAZARD (Give details)
ALLERGIC PERSONS PROHIBITED (Specify allergy)
Emergency Handling Control Categories
Page 3 of 5
CATEGORY
Main
Division
A
1
2
3
4
5
B
1
2
3
4
5
6
7
8
C
1
2
3
4
5
6
7
8
D
1
2
3
4
5
6
7
8
PROCEDURE
IMMEDIATE ACTIONS
Evacuate all staff from area and seek assistance
Shut off all sources of ignition
Contain and isolate spillage and warn all relevant personnel in the area
Contact Supervisor, Technician, or Dept Manager for advice as appropriate
Ventilate area
PROTECTIVE EQUIPMENT TO USE WHEN DEALING WITH SPILLAGE
Same as general handling categories
Disposable nitrile or latex gloves, lab coat or equivalent
Disposable nitrile or latex gloves, lab coat or equivalent and safety glasses
Disposable nitrile or latex gloves, lab coat or equivalent and a disposable facemask
Protective footwear
Disposable nitrile or latex gloves, lab coat and powered respirator with safety visor
Disposable nitrile or latex gloves, disposable overalls and powered respirator with
safety visor
FOR LARGE SPILL contact trained personnel to use Self-Contained Breathing
apparatus
Specific equipment (give full details)
METHODS OF DEALING WITH SPILLAGE
Wipe up with damp tissue/towel
Sweep up and place in suitably labelled bag for disposal
Wash area with copious amounts of water and run to drain
Absorb on vermiculite/sawdust/absorbent sock/sand and dispose
Ventilate area to dispel residual vapour
Wash spillage with 1% hypochlorite solution
Treat spillage with sodium hydrogen carbonate powder (weak acid spillage)
Treat spillage with specified reagent (please specify)
IF EXPOSURE TO PERSONNEL IS SUSPECTED
Wash exposed area with water and dry
Irrigate exposed area with copious amounts of water using tap, wash bottles or
drench showers where appropriate
Remove any contaminated clothes
Remove person to fresh air
Contact Supervisor, Technician, or Dept Manager immediately for advice
Contact First Aider and follow procedure documented in the current edition of the
Department Safety Handbook
Seek medical aid immediately
Refer to Material Safety Data sheets for specific first aid
Page 4 of 5
Substance Hazard Codes for CoSHH Assessment
Hazard Code 1
Hazard Code 2
Hazard Code 3
Hazard Code 4
Substances which are considered to carry a
low level of severity including those without
any indication of danger
Substances which carry a medium level of
severity. These include:
Flammable
Highly Flammable
Irritant (R36, R37, R38)
Corrosive (R34, R35)
Harmful Substances (R20, R21, R22) but not
Category 3 carcinogens/mutagens/toxic to
reproduction and sensitisers)
Substances considered to carry a high level
of severity. These include:
Explosive
Oxidising
Extremely Flammable
Harmful (Category 3
carcinogens/mutagesns/toxic to
reproduction and sensitisers)
(R40, R42, R43)
Toxic (including Category 2 carcinogens,
mutagens, toxic to reproduction)
(R23, R24, R25, R45, R46, R48, R49, R60,
R61, R62, R63)
Very toxic (R26, R27, R28, R39)
Severity level 4 is only used where there is
an exceptional hazard e.g. able to cause
acute or chronic health effects at low levels
of exposure or where statutory controls are
in place concerning the substance.
This level includes all Category 1
carcinogens, mutagens, and substances
toxic to reproduction (R45, R46, R48, R49,
R60, R61, R62) NOTE: this level may also
include some substances labelled Very
Toxic (R26, R27, R28, R39)
Any substance within this category requires
a full written risk assessment and approval
by the Departmental Safety Officer before
ordering.
Page 5 of 5