| COSHH
Assess No. | | Site
Responsible Person: | |
| | | |
| Location
| | Generic
Chemical Name | | | | | |
| Data
Sheet | | Where
are Data Sheets Kept | |
| | | |
| Substance
Manuf | | | |
| | | |
| Tel
No.: | | Fax
No.: | | | | | |
Approx.
Quantity Held | | Production
Storage Area | | | | | |
| International
ID No. | | Form
of Supply, Use or Despatch | |
CAS/UN
etc Main
Hazard From:
VAPOUR,
LIQUID,
GAS,
FUME,
DUST,
BULK
SOLID,
OTHER GIVE
DETAILS
| Summary
of Hazards: | | |
What
do you currently use this substance for? | |
How
do you currently Control this Risk? Is
a CPL label attached to the container in use? YES NO - If not why? Which
CPL label is attached to the container in use?
IRRITANT,
CORROSIVE,
TOXIC,
VERY TOXIC,
FLAMMABLE,
HAZARDOUS TO THE ENVIRONMENT,
OTHER.
GIVE DETAILS: What
is the likely cause of employee exposure? What
first aid is recommended after accidental contact? What
is the likely route of entry into an employee?
INGESTION,
INHALATION,
INJECTION (Through open wound),
ABSORPTION (see HSE guidance EH40,
OTHER
GIVE
DETAILS Is
health surveillance required if an employee is using this exposed to this substance?
YES / NO
| Greencore
Group No.: | | | HSE
No. | | Employees
at Risk:
OPERATOR,
DRIVER,
SUPERVISOR,
LAB TECHNICIAN,
SAMPLE CONTROLLER,
ADMIN STAFF,
ENGINEER,
CONTRACTOR,
VISITORS
OTHER GIVE DETAILS:
Occ
Exposure Standard & Source & Information Air
Quality Measurement Results,
if required etc.: Is
action required as a result of this COSHH assessment? Is
the way you use this substance acceptable? Is
Personal Protective Equipment required? YES NO
HARD HAT,
GOGGLES,
FACE SHIELD,
BREATHING APPARATUS
AIR LINE,
RESPIRATOR
FACE MASK,
CHEMICAL SUIT,
BOOTS,
WELLINGTONS,
WADERS,
GLOVES,
OTHER: GIVE
DETAILS
| Procedure
Review Effective | YES
NO | | |
Spillage
Assessment No. ONGOING
AIR MONITORING FREQUENCY DETAILS:
| LEV
required LEV
inspected every 14 months
by a competent Engineer | YES
NO YES
NO | | Dilution
ventilation: Definition
of LEV = Local Exhaust Ventilation See
also LEV Assessment No.: DETAILS
| YES
NO
|
| PPE
Maintained & Inspected | YES
NO | | See
Local Issue Record: | |
| Training
Programme Established | YES
NO | | | |
What
training is required for this hazardous substance?
| Frequency
future reviews: | | External
report details: | |
Assessor's
Additional Remarks & Requirements:
| ASSESSOR
| RESPONSIBLE
PERSON | DATE
| | Signature:
| | Signature:
| | |
| Position:
| | Position:
| | |
| PRINT
NAME | | PRINT
NAME | | |
REVIEW
OF COSHH ASSESSMENT ASSESSMENT
NO. __________ This
assessment has been reviewed on the dates listed below.
There has been no
change or, if withdrawn from use, details are listed in Remarks Column. NOTE:
A Signature is not required for printed data.
| Date
| Reviewed
By | Remarks
| Signature
| | | | | | | 
