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COSHH RISK ASSESSMENT
Form # HSEQ – COSHHRA (Rev 3 - Mar 23)
Project Name: Ref Number:
Note: To be completed for each chemical separately.
SUBSTANCE INFORMATION
Chemical Name
Date
Received
Quantity
Received
Are any of these substances:
(See warning label on packaging or MSDS)
Are any of these substances
hazardous to health:
Extremely
Flammable
(F+)
Highly
Flammable
(F)
Explosive
(E)
Oxidising
(O)
Very
Toxic
(T+)
Toxic
(T)
Corrosive
(C)
Harmful
(Xn)
Irritant
(Xi)
Dangerous
for
Environment
(N)
When
in
contact
with
skin
When
in
contact
with
eyes
When
breathed
in
When
swallowed
Carcinogen
/
Mutagen
/
Teratogen
Chemical Reactions: Any material or chemical this
substance must not come into contact with? 
If this substance is extremely
flammable state lowest flash point 
If appropriate, work only to be
carried out by these named people 
CONTROL MEASURES
Can less dangerous substance be
used?  Yes / No
If so, why are they not
being used? 
Does this substance have Workplace
Exposure Limits (WEL)?  Yes / No If so, give details below  Engineering Controls
Personal Protective
Equipment (PPE)
Groups at risk
TWA (8 hours)
Short Term Exposure Limit
(STEL) (15 min)
Open
Bench
Local
Exhaust
Ventilation
(LEV)
Fume
Cupboard
Total
enclosure/
Glove
Box
Other:
Goggles
/
Facemask
Respirator
Gloves
Protective
clothing
Staff
Workers
Suppliers
Subcontractor
s
Visitors
Other:
Controls measures in place to minimise risk 
Additional info (e.g. type of gloves) 
OTHER PRECAUTIONS AND EMERGENCY MEASURES
COSHH RISK ASSESSMENT
Form # HSEQ – COSHHRA (Rev 3 - Mar 23)
First Aid: What Action should be taken if this substance is:  How should an accidental release / spillage be dealt with? 
Swallowed:
In contact with Skin:
Fire Precautions: What actions will be taken in the event of a fire involving this substance? 
In contact with Eyes:
Disposal: How should this substance be disposed of? 
Breathed in:
Sources of Information
(e.g. Suppliers MSDS) 
Is heath surveillance required? Yes / No Is training required for this process? Yes / No
DECLARATION REASSESSMENT
Assessment
completed By:
Name: Signature: Date: Date for reassessment Review Date Reviewed By
Supervisor:
Name: Signature: Date:
HSE In Charge:
Name: Signature: Date:

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COSHH RISK ASSESSMENT Form # HSEQ - COSHHRA Rev 3.doc

  • 1. COSHH RISK ASSESSMENT Form # HSEQ – COSHHRA (Rev 3 - Mar 23) Project Name: Ref Number: Note: To be completed for each chemical separately. SUBSTANCE INFORMATION Chemical Name Date Received Quantity Received Are any of these substances: (See warning label on packaging or MSDS) Are any of these substances hazardous to health: Extremely Flammable (F+) Highly Flammable (F) Explosive (E) Oxidising (O) Very Toxic (T+) Toxic (T) Corrosive (C) Harmful (Xn) Irritant (Xi) Dangerous for Environment (N) When in contact with skin When in contact with eyes When breathed in When swallowed Carcinogen / Mutagen / Teratogen Chemical Reactions: Any material or chemical this substance must not come into contact with?  If this substance is extremely flammable state lowest flash point  If appropriate, work only to be carried out by these named people  CONTROL MEASURES Can less dangerous substance be used?  Yes / No If so, why are they not being used?  Does this substance have Workplace Exposure Limits (WEL)?  Yes / No If so, give details below  Engineering Controls Personal Protective Equipment (PPE) Groups at risk TWA (8 hours) Short Term Exposure Limit (STEL) (15 min) Open Bench Local Exhaust Ventilation (LEV) Fume Cupboard Total enclosure/ Glove Box Other: Goggles / Facemask Respirator Gloves Protective clothing Staff Workers Suppliers Subcontractor s Visitors Other: Controls measures in place to minimise risk  Additional info (e.g. type of gloves)  OTHER PRECAUTIONS AND EMERGENCY MEASURES
  • 2. COSHH RISK ASSESSMENT Form # HSEQ – COSHHRA (Rev 3 - Mar 23) First Aid: What Action should be taken if this substance is:  How should an accidental release / spillage be dealt with?  Swallowed: In contact with Skin: Fire Precautions: What actions will be taken in the event of a fire involving this substance?  In contact with Eyes: Disposal: How should this substance be disposed of?  Breathed in: Sources of Information (e.g. Suppliers MSDS)  Is heath surveillance required? Yes / No Is training required for this process? Yes / No DECLARATION REASSESSMENT Assessment completed By: Name: Signature: Date: Date for reassessment Review Date Reviewed By Supervisor: Name: Signature: Date: HSE In Charge: Name: Signature: Date: