COSHH Form Template

Utilize this COSHH Form Template to document hazardous substances, their risks, and control measures in compliance with health and safety regulations.

COSHH Form Template



General Information

1. Department


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2. Details of the persons involved in COSHH Assessment


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3. Who are the people at risk?


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Hazard Identification

1. Process


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2. How long will it take?


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3. How often will it be repeated?


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4. How much substance is used?


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5. Location of the process or work being carried out


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6. Classify the hazard


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7. Which state / form does the substance take?


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8. How does the exposure to the substance take place?


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Workplace Exposure Limits (WEL)

1. Long-term exposure level


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2. Short-term exposure level


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3. List the risks to health below from exposure to the substance


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Control Measures

1. List below the control measures


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2. Is health surveillance or monitoring required?


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Personal Protective Equipment

1. Identify type and specification


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2. Provide standard measures for each PPE required


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First Aid Measures

1. What are the first measures when there is any contact with these chemicals?


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Storage And Disposal Of Substances And Contaminated Containers

1. How do you store these substances?


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2. What are the means of disposing hazardous waste?


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Summary

1. Is the exposure adequately controlled?


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2. Risk rating after following control measures


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3. Any additional comments / observations


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Checklist by GoAudits.com – Please note that this checklist is intended as an example. We do not guarantee compliance with the laws applicable to your territory or industry. You should seek professional advice to determine how this checklist should be adapted to your workplace or jurisdiction.

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