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COSHH risk assessment form

Use this Control of Substances Hazardous to Health (COSHH) form, to control the exposure to dangerous substances and to prevent hazardous diseases and health problems. Identify the risks associated with the activity or work process obeyed and record all improving and examine measures as well as personal protection gear and tools that you and your team are using when dealing with these substances. 

Log all first aid steps in case of emergencies. Next record averages of disposing of dangerous wastes and contaminated containers. Finally, summarise the report by giving a risk rating after following the control measures. Use Lumiform to conduct better risk evaluations to decrease or eliminate health risks.

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General Information
Participants in COSHH assessment
People who are at risk
Hazard Identification
Add activity or work process:
How long will it take?
How often will you repeat it?
How much material is used?
List the risks to health from exposure to the substance
Hazard definition
Indicate which form the substance takes
Indicate which route(s) of exposure the substance takes
Exposure limits at workplace
Short-term exposure level
Long-term exposure level
Control Measures
Name control measures e.g. extraction, ventilation, observation, include further controls for vulnerable persons where necessary
Is health surveillance or monitoring needed? (remember health surveillance may be needed for vulnerable persons, e.g. pregnant/young employees, those with asthma, dermatitis etc.)
Personal Protective Equipment
Identify type and specification of PPE
Provide standard measures for each PPE needed
First Aid Measures
Explain first measures when in contact with these substances
Storage and Disposal of Substances and Contaminated Containers
How do you deposit these substances?
Means of disposing dangerous waste
Is the exposure sufficiently controlled?
Rate the risk after following control measures:
Name and signature of the inspector:
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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
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