Go digital today! fl Convert your paper checklists into digital forms : Scan this QR code to use this paper checklist on your smartphone or z tablet or visi htps://safetycuture.com/ : SafetyCulture EER Title Page Client / site Location Conducted on Prepared by General Information Department Persons involved in COSHH Assessment People at Risk Llemployees Cistudents Li vulnerable persons Cothersother people at risk Hazard Identification Add + activity or work process Process How long will it take? How often will it be repeated? How much substance is used? Locaton of the process or work being carried outHazard Acute Very Corrosive Harmful Explosive Serious Respiratory Serious Oxic Toxicity Toxic eye Sensitiser long (fatal) irritation term health hazard Indicate below which form the substance takes O oO oO OQ O © OO Loother Gas Vapor Mist. Fume Dust Liquid Soild _state/form Indicate below which route(s) of exposure the substance takes Inhalation Skin Eyes Ingestion Other state Workplace Exposure Limits (WELs) Long-term exposure level Short-term exposure level List the risks to health below from exposure to the substance Control Measures List below control measures eg extraction, ventilation, supervision, include additonal controls for vulnerable persons where necessaryIs health surveillance or monitoring required? (remember health surveillance may be required for vulnerable persons eg pregnant/young workers those with asthma, dermatitis etc) Yes No NIA Personal Protective Equipment Identify type and specification Dust mask Respirator Gloves Footwear Visor Goggles Overalls Other Other PPE Provide standard measures for each PPE required First Aid Measures Write first measures when in contact with these chemicals Storage and Disposal of Substances and Contaminated Containers How do you store these substances? Means of Disposing Hazardous Waste Skip Return to Depot Return to Supplier OtherOther means Summary Is the exposure adequately controlled? Yes No NIA Risk rating after following control measures HIGH MEDIUM Low Completion Full Name and Signature of the Inspector solutions. The template are intended tobe used as hypothetical examples only and should not be used asa substitute for professional advice. ‘You should seck your oon professional adie to determine the use ofa templates permisiblein your worxplace o ursdlction. You should Independent determine whether the templates suitable or your creumstances