COSHH Form Template
COSHH Form Template
COSHH Form Template
Substance(s) Used
Quantity
Quantity
Chemical Reactions: Any material or chemical these substance(s) must not come into contact with?
PROCESS INFORMATION
Brief description of process and controls in place minimise risk
CONTROL MEASURES
Can less dangerous substances or processes be used? Do any substances used have Workplace Exposure Limits (WEL)? Substance
If so, why are they not being used? If so, give details below STEL (15 min)
Open Bench OK / None
Engineering Controls
Other: Local Exhaust Ventilation (LEV) Total enclosure/ Glove Box Fume Cupboard
Groups at risk
Other: Expectant Mothers
Students / Researchers
Visitors / Contractors
Respirator
Children
Gloves
Staff
Controls measures in place to minimise risk Additional info (e.g. type of gloves)
Fire Precautions: What actions will be taken in the event of a fire involving these substance(s)?
In contact with Eyes: Disposal: How should these substances be disposed of (or not disposed of)? Breathed in:
Yes / No
Yes / No
REASSESSMENT
Date for reassessment Review Date Reviewed By
DECLARATION
Assessment completed By: Supervisor: Departmental Safety Officer: Name: Name: Name: Signature: Signature: Signature: Date: Date: Date: