Doc. n.

FORM-BOSS-HSE-101-01-E
BOS SHELF LLC
Rev. 02 Date:04/04/2018
COSHH ASSESSMENT FORM
Page 1 of 4

Substances that come under the COSHH Regulations are those listed under the Packaging
and Labelling of Dangerous Substances or those listed in the current Health and Safety
EH40 Publication that have been assigned EH/40 2005 Workplace Exposure Limit (WEL)
Risks to health from Asbestos, Lead, Heat, Cold, Noise, Fire, Explosion, Radiation,
Pressure or Electricity are covered under separate legislation.

SECTION 1 DETAILS OF SUBSTENCES USED OR GENERATED

1A Brief description of work activity:

Application of CorrLube VpCI Lithium EP Grease during material management
preservation activity

YES NO
Risk Assessment No.
1B Location CA-LBPR 001

1C Substance Names CorrLube™ VpCI® Lithium EP Grease

1D List most hazardous EH/40 2005 Workplace Exposure Limit (WEL)

Ingredients
Occupational exposure limits: None

1E Substance Hazard Classification

Tick Appropriate Boxes
Irritant X Harmful Corrosive Toxic Very Toxic

Dust Carcinogen or suspected carcinogen Micro-organism

Teratogenic Mutogenic

1F Physical Form
Solid Liquid Gas Mist Fumes

Grease X Cream Aerosol

 Doc. n. FORM-BOSS-HSE-101-01-E
BOS SHELF LLC
Rev. 02 Date:04/04/2018
COSHH ASSESSMENT FORM
Page 2 of 4

SECTION 2 HAZARD EVALUATION

2A Working Environment Risk Phrase:
Warning
Complete Appropriate Boxes
Open Area X Tented Area Enclosed Area Confined Space
No. of person No. of person Other persons
Carrying out Task 2 In close proximity likely to be affected
2B Could a less hazardous substance (or form of
the substance) be used instead? YES NO X
Justify not using it: Less hazardous substances are used wherever possible.
2C Assessed Duration of Exposure
Tick appropriate Box Frequency As Required
Daily Exposure
Less than 1 hour 1 to 4 hours X 4 to 8 hours 8 to 12 hours
2D Route of Entry
Ingestion Inhalation X Contact with skin or X Injection
Eyes

Skin Absorption

2E Effect of Exposure
Tick Appropriate Boxes
Effects to Skin Eyes Respiratory System Nervous System
Irritant if in contact or inhaled X X
May cause sensitisation to
Possible long-term effect to
Carcinogenic or potential to X
Prolonged exposure may cause Genetic problems
2F Level of Risk (Before Considering Control Measures)
Based on the information given in Sections 1, 2 tick appropriate Box
No Risk Low Risk Low Risk but level may increase High Risk X
IF THERE IS NO RISK GO TO SECTION “ 3 F ”
2G Training required to carry out activities
Tick appropriate Box
TBT Specific Training X Emergency Spill Response
 Doc. n. FORM-BOSS-HSE-101-01-E
BOS SHELF LLC
Rev. 02 Date:04/04/2018
COSHH ASSESSMENT FORM
Page 3 of 4

SECTION 3 CONTROL MEASURES

3A Engineering Controls:

3B Personal Protective Equipment:

Tick Appropriate Boxes
Hand Protection X Face Protection Eye Protection X Respiratory Protection
Type :
Body Protection X Foot Protection X Any Additional Protection

Define the Protective Gloves I.E., Nitrile, Viton, Neoprene

Above Eye protection: Goggles recommended during refilling.
Body protection: Protective work clothing.
Use suitable respiratory protective device in case of insufficient ventilation.

Use local exhaust ventilation to control airborne concentrations below exposure

limits. · General protective and hygienic measures
Immediately remove all soiled and contaminated clothing
Wash hands before breaks and at the end of work.
3C Management measures:

3D Level of Risk (After considering the above)

Based on the information given tick appropriate Box
No Risk Low Risk Low Risk but level may increase X High Risk
3E Is health surveillance required? - Yes
3F First Aid Measures

Inhalation: Supply fresh air and to be sure call for a doctor. In case of unconsciousness
place patient stably on side position for transportation.
Eye Contact: Rinse opened eye for several minutes under running water.
Skin Contact: Immediately wash with water and soap and rinse thoroughly. If skin irritation
continues, consult a doctor.
Ingestion: If symptoms persist consult doctor.

SECTION 4 STORAGE AND DISPOSAL

4A Storage: Store in cool, dry place in tightly closed receptacles. Ensure good
ventilation/exhaustion at the workplace. Prevent formation of
aerosols.
4B Disposal: Dispose of in accordance with local, state, and federal regulations. foul
sewer but processed in a suitable effluent treatment plant.

Type of Waste Generated: Grease - oil

Disposal Company: SPS CWAA
Final Destination: TBA
 Doc. n. FORM-BOSS-HSE-101-01-E
BOS SHELF LLC
Rev. 02 Date:04/04/2018
COSHH ASSESSMENT FORM
Page 4 of 4

SECTION 5 ASSESSMENT TEAM

NAME POSITION SIGNATURE
Assessed by German Gereykhanov HSE Advisor
Assessed by Anar Tahmazli Superintendent
Assessed by Imran Zakariyayev HSE Manager