Loughborough University Health & Safety COSHH Blank COSHH Assessment Description Site Originating department Are hazardous substances likely to be present in the workplace? 1. Substances:- Yes No Substance/Brand Name Form Quantity Used 2. People at Risk:- People at Risk Departments No of people at risk 3. Hazards :- Consider whether the substances have exposure limits, are they irritants, their toxicity, what will be the effects on those who may not work directly with the substances but work in that area or may be affected by emissions from the activity. Remember to include substances produced or given off by a process, as a result of an accident or at the end of the process. Hazard to health Exposure limits 'Without control measures' are any of the substances in a form in which they could be:- 3.1 Inhaled? 3.2 Absorbed through the skin or eyes? 3.3 Swallowed? 3.4 Injected into the body by high pressure equipment or contaminated sharp objects? 10:22:03, 31/05/2007 Page 1 of 5
4. Effects of the Substances:- For the quantities of substances used in this assessment and frequency of use:- 4.1 Could serious effects or death occur from a single exposure to the substances? 4.2 Could the substances cause sensitisation, allergic reactions or asthma? 4.3 Could the substances cause dermatitis? 4.4 Could adverse effects or death occur from repeated, even low level, exposures over a period of time? 4.5 Could the substances be harmful to the human reproductive process? 4.6 In the case of micro-organisms, could they cause infection or an infected person infect others? 4.7 Could cancers occur? 4.8 Do the substances have a Workplace Exposure Limit (WEL)? 5. Control Measures:- Control measures in use Emergency procedures First aid 5.1 Have employees been notified of the risks and control measures? 5.2 Can the substance(s) be eliminated or substituted for something less hazardous? 5.3 Can the process be enclosed or contained? 5.4 Can a better process or system of work be adopted? 5.5 Can the number of employees or time exposed be reduced? 5.6 Can housekeeping be improved or adapted? 5.7 Is appropriate storage provided? 5.8 Is local exhaust ventilation required? Yes No 5.9 Is personal protective equipment required? Yes No 10:22:03, 31/05/2007 Page 2 of 5
5.10 Is respiratory protective equipment required? Yes No Protective Equipment Disposal Reason for selection of PPE/RPE 6. What is the Chance of Exposure Occurring:- Using the control measures is it possible for people noted in the 'People' section to be exposed to the hazards of the material if they:- 6.1 Work with them directly? 6.2 Are in the vicinity of where they are being handled, transported, used, stored, disposed of, discharged or given off? 6.3 Are in the vicinity of an accidental release or spillage? 6.4 Enter an enclosed space where they might be present? 6.5 Disturb deposits and make them airborne? 6.6 Wear previously contaminated clothing? 6.7 Come into contact with contaminated surfaces? 6.8 Could the substance be passed on to them from someone else, e.g. from personal contact or contaminated clothing? 7. Action Steps:- 7.1 Is control adequate? Yes No Risk status Hazard status Brief Description Comment Person Responsible Budget cost ( )/ Target completion date 10:22:03, 31/05/2007 Page 3 of 5
8. Training:- 8.1 Is training required? Yes No Training date Training procedure 9. Monitoring:- 9.1 Is monitoring required? Yes No 9.2 Is air sampling required? Yes No Monitor interval (weeks) Monitored by Next monitor Monitoring 10. Health Surveillance:- 10.1 Is health surveillance required? Yes No Surv'nce int (weeks) Next survey Health surveillance requirements 11. Safe System of Work:- 10:22:03, 31/05/2007 Page 4 of 5
12. Conclusions:- Rate of production Exposure frequency Conclusions Person responsible Assessment date Asses't interval (weeks) Review date Signed (assessor) Authoriser Date authorised Authoriser comments Signed (authoriser) 10:22:03, 31/05/2007 Page 5 of 5