Form
HS40
Dangerous (Hazardous) Substances - Health & Safety Self-Assessment checklist
1
Dangerous substance Use
1.1
Are you aware of the requirements
to employers under the Control of
Substances Hazardous to Health
Regulations (COSHH)?
Yes
No
N/A
Further
action
required?
(Please refer to COSHH, a brief
guide to the regulations attached).
1.2
Do you use, have contact with or
store dangerous substances in your
workplace?
1.3
Have you listed all hazardous
substances and where relevant
obtained the makers Health &
Safety data sheets for each
substance?
1.4
If you employ five or more
employees have you recorded your
assessment and the significant
findings of the risks to health (using
the data sheet) for each substance
used or created by work activities?.
1.5
Have you considered substitution in
favour of a less dangerous or userfriendly substance?
1.6
If substitution is not possible are
control measures in place sufficient
to reduce the risk of harm to
persons from the use of hazardous
substances, i.e. adequate
ventilation, use of respirators,
protective gloves, goggles etc.?
NOTE. Respirators must be of the
correct type for the job to hand and
if not disposable must be regularly
cleaned and checked, recording all
details.
1.7
Is all information regarding the
storage and use (including spillage’s
and cleaning procedures) of
hazardous substances readily
available and passed down in the
form of training to all employees
(including contractors where
applicable)?
Is all information and training given
to staff recorded?
D:\116092305.doc
European Week for Safety and Health 13th October –17th October 2003
Comments ……
1.8
Where applicable*, do you monitor
the exposure of employees to
hazardous substances?
(*Refer to COSHH booklet)
1.9
If your assessment has shown that
health surveillance* is required (e.g.
from product data sheet advice or
specific COSHH requirements) are
appropriate arrangements in place?.
(*Refer to COSHH booklet)
1.10
Do your control measures
adequately reduce or eliminate the
risk of staff being harmed by
hazardous substances?
1.11
Do you have adequate first aid and
welfare facilities?
Company name
…………………………………………………………………………….…
Address
………………………………………………………………………………..
………………………………………………………………………………..
Name of assessor
.……………………………………………………………………………....
Position
…………………………………………………………………………..……
Date
/
/ 2003
Please send a copy of your completed form to:Graham Bailey, Environmental Health (Health & Safety),
Community Services,
Environmental Health
Trevanion Road,
Wadebridge,
Cornwall,
PL27 7NU
Would you like further advice on Controlling Substance Hazardous to Health?
COSHH Action Pack.
Yes
no
(please circle)
I would like a visit from an Officer.
Yes
no
(please circle)
D:\116092305.doc
European Week for Safety and Health 13th October –17th October 2003