INTEGRATED MANAGEMENT SYSTEM

HAZARDOUS CHEMICALS ASSESSMENT SHEET

HAZARD CHEMICAL ASSESSMENT SHEET: PART 1
Substance Name / Description:
PROJECT: Date:
Company:
Supplier / Manufacturer: Tel. No:
Where Stored: Quantity:
Chemical Composition:
Data Sheet Received?: Attached?: Yes / No
Workplace Exposure Level
(WEL):
RISK CLASSIFICATION: Please identify the classification of chemical by (√) marks

Explosive Oxidizing Very Toxic Toxic Corrosive Harmful Irritant

Radioactive Flammable Extremely Carcinogenic Sensitizers Dangerous to Other

Flammable Environmental Risks:

WORK ACTIVITY ASSESSMENT:

Location:

Operation:

Principal Hazards:
Frequency Of
Exposure:
Location Type: i.e.
Outside, Well Ventilated,
Confined Space etc
EXPOSURE RISKS
SKIN
INGESTION INHALATION ABSORPTION
CONTACT
Workers Exposed:

Job Type: Numbers Involved:

HAVE SAFER ALTERNATIVES BEEN CONSIDERED?

Alternatives:

This document becomes UNCONTROLLED once printed from the official CD or server Document No HSE-F-61
location
Version Date 12.03.14
 INTEGRATED MANAGEMENT SYSTEM
HAZARDOUS CHEMICALS ASSESSMENT SHEET
COSHH ASSESSMENT SHEET: PART 2
Substance Name / Description:

CONTROL MEASURES ACTIONED:

Ventilation:

Fire Precautions /
Extinguisher Type:
Storage Required:

Special Transport:

Disposal Issues:

MONITORING: Yes No Details

Routine Health Surveillance

Personal Sampling
Atmospheric Sampling
Statutory Examination of PPE
PERSONAL PROTECTIVE EQUIPMENT
Overalls Aprons Skin Creams
Eye/Face
Gloves – PVC Rubber Gauntlets
(Specify)
Respiratory
Arm Protection Leg Protection (if req’d dry
cement)
Others - Specify
Susceptible Employees?

PROVISION OF INFORMATION Yes No Details

Signs & Notices at Workplace
Written Info for All Employees
Written Info for Employees at Risk
Instruction to Employees at Risk

SUMMARY ASSESSMENT OF CONTROL OF HAZARDS:

SIGNATURE OF
JOB TITLE: DATE:
ASSESSOR:

This document becomes UNCONTROLLED once printed from the official CD or server Document No HSE-F-61
location
Version Date 12.03.14