Free COSHH Assessment Template

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Free COSHH Assessment Template

COSHH Assessment

General Information

Criteria

Details

Assessment Reference No.

Assessor's Name

Date of Assessment

Department/Location

Substance/Product Name

Purpose/Use of Substance

Substance Identification

Criteria

Details

Rating

(1-5)

Hazard Classification

Flammable Liquid, Irritant

Physical Form

Liquid

Route of Exposure

Inhalation, Skin Contact

Manufacturer/Supplier Info

NovaChem Industries, Tacoma, WA 98401

Hazard Evaluation

Criteria

Description

Rating

(1-5)

Potential Health Effects

Eye irritation, dizziness from vapor, skin dryness

Environmental Impact

Toxic to aquatic life if released in large quantities

Risk of Fire/Explosion

Yes – highly flammable

Emergency Response Needed

Evacuate area, use fire extinguisher (Class B)

Exposure Risk Assessment

Task/Activity

Frequency

Duration

Number of Workers Exposed

Control Measures

Cleaning lab equipment

Transferring to smaller containers

Control Measures

  • Engineering Controls:

  • Administrative Controls:

  • Personal Protective Equipment (PPE):

Storage and Disposal

Criteria

Details

Rating

(1-5)

Storage Requirements

Store in a cool, dry, well-ventilated area away from ignition sources.

Spill/Leak Response

Use absorbent material to contain spills. Dispose of as hazardous waste.

Disposal Method

Collected by licensed waste management service.

Assessment Conclusion

Criteria

Details

Overall Risk Rating

Further Actions Required

Review Date

Approval

Name

Position

Signature

Date

Ensure that this assessment is reviewed regularly and updated as necessary to maintain a safe and compliant work environment.

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