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Cf-hsf-022 Coshh Assessment Form (CLP)

This document contains a COSHH (Control of Substances Hazardous to Health) assessment form for an unnamed chemical or substance. The multi-page form includes sections to identify hazards, likely exposure routes, required personal protective equipment, first aid measures, firefighting measures, risk evaluation, spill procedures, disposal procedures, and training requirements. It notes that a COSHH assessment is required under the company's safety policy when a substance has certain risk phrases or other hazards dictate it.

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leonirvingrdfl
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587 views

Cf-hsf-022 Coshh Assessment Form (CLP)

This document contains a COSHH (Control of Substances Hazardous to Health) assessment form for an unnamed chemical or substance. The multi-page form includes sections to identify hazards, likely exposure routes, required personal protective equipment, first aid measures, firefighting measures, risk evaluation, spill procedures, disposal procedures, and training requirements. It notes that a COSHH assessment is required under the company's safety policy when a substance has certain risk phrases or other hazards dictate it.

Uploaded by

leonirvingrdfl
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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COSHH ASSESSMENT FORM CF-HSF-022 Page no: Page 1 of 3 Issue date: 7/21/2008 JOHN HOLDEN GROUP OF COMPANIES

Policy : CP-OHP 15 Issue No: 2.0 Issued by: Group H&S Officer Authorised by: Group HSE Committee

CHEMICAL / SUBSTANCE PRODUCT NAME RISK PHRASES: SAFETY PHRASES: LEVEL of RISK (personal judgment) complete after adding controls
LIKELIHOOD SEVERITY Risk Rating Risk LxS= R Response
Negligible Unlikely

Likelihood
Likely Probable Very Likely

Very likely Probable Likely Unlikely Negligible

5 4 3 2 1

Very High High Medium Low Very Low

5 4 3 2 1

Intolerabl e Intolerabl e Substanti al Tolerable Trivial

17 to 25 13 to 16 9 to 12 5 to 8 1 to 4

Unacceptable Unacceptable Early attention Regular attention Monitor

Consequence

1 5 4 3 2 1 5 4 3 2 1

2 10 8 6 4 2

3 15 12 9 6 3

4 20 16 12 8 4

5 25 20 15 10 5

APPROVED METHOD OF USE (A brief description of how the substance is to be used) (Provide a brief description
of how the hazards are currently controlled)

Who is likely to be affected by the substance? X Workshop Trades Site Operatives Other employees in the Sub Contractors vicinity SUMMARY of HAZARDS (Hazards identified on the container or safety data sheet) X

Explosiv e

Corrosive

Compress ed Gas

Flammabl e Gas

Oxidisin g Gases

Respirato ry sensitizer

LIKELY ROUTE AND CAUSE OF EXPOSURE X SKIN EYES TERM OF EXPOSURE DAILY WEEKLY PERSONAL PROTECTIVE EQUIPMENT X Safety shoes or boots with chemical resistant sole Safety glasses chemical resistant

Irritant, Toxic (class 4 only)

Toxic (class 1,2,3) INHALATION YEARLY

Environme ntally Hazardous

INGESTION MONTHLY

Suitable fume mask can be worn. However not consider to be essential, with use in well ventilated areas

Standard company work wear


1

It is current safety policy that a written COSHH assessment must be provided when a substance to be used has been assigned any of the risk phrases R42, R43, R45, R46, R48, R49, R60 or R61. Other hazards may also dictate the preparation of a suitable COSHH assessment.

COSHH ASSESSMENT FORM CF-HSF-022 Page no: Page 1 of 3 Issue date: 7/21/2008 JOHN HOLDEN GROUP OF COMPANIES

Policy : CP-OHP 15 Issue No: 2.0 Issued by: Group H&S Officer Authorised by: Group HSE Committee
At all times when working close to Fork Lift Trucks

Chemical resistant gloves (Nitrile)

2 It is current safety policy that a written COSHH assessment must be provided when a substance to be used has been assigned any of the risk phrases R42, R43, R45, R46, R48, R49, R60 or R61. Other hazards may also dictate the preparation of a suitable COSHH assessment.

COSHH ASSESSMENT FORM CF-HSF-022 Page no: Page 1 of 3 Issue date: 7/21/2008 JOHN HOLDEN GROUP OF COMPANIES

Policy : CP-OHP 15 Issue No: 2.0 Issued by: Group H&S Officer Authorised by: Group HSE Committee

FIRE FIGHTING MEASURES X HYDROSPRAY Safe for wood, paper and tex tiles CO Safe for flammable liquids and electrical fires

FOAM Safe for wood, paper, textiles and flammable liquids

WATER Safe for wood, paper and textiles

ABC DRY POWDER Safe for wood, paper, textiles, flammable liquids and gaseous fires

DRY POWDER SPECIAL METAL Safe for flammable metals, including Titanium

RISK (From use of above)

EYES

FIRST AID MEASURES HARMFUL EFFECTS X SKIN INHALATION

INGESTION

SPILL PROCEDURE

DISPOSAL PROCEDURE TRAINING REQUIRED X HEALTH MONITORING REQUIRED X Additional Comments Additional Comments

ASSESSMENT RESULTS (FURTHER CONTROLS) Actions Required X Actions Required X Actions Required X Assessment Completed by: Next review Date: Signature: Date:

3 It is current safety policy that a written COSHH assessment must be provided when a substance to be used has been assigned any of the risk phrases R42, R43, R45, R46, R48, R49, R60 or R61. Other hazards may also dictate the preparation of a suitable COSHH assessment.

COSHH ASSESSMENT FORM CF-HSF-022 Page no: Page 1 of 3 Issue date: 7/21/2008 JOHN HOLDEN GROUP OF COMPANIES

Policy : CP-OHP 15 Issue No: 2.0 Issued by: Group H&S Officer Authorised by: Group HSE Committee

COSHH EMPLOYEE POINT OF USE INFORMATION SHEET Product Name: CHEMICAL SYMBOL:

Control Measures:

First Aid Eyes Skin

Inhalation

Ingestion

Personal Protective Equipment (PPE) X

FIRE FIGHTING MEASURES X ABC DRY POWDER Safe for wood, paper, textiles, flammable liquids and gaseous fires DRY POWDER SPECIAL METAL Safe for flammable metals, including Titanium

WATER

HYDROSPRAY

CO Safe for flammable liquids and electrical fires

FOAM Safe for wood, paper, textiles and flammable liquids

Safe for wood, paper and textiles

Safe for wood, paper and textiles

RISK (From use of above)

Spillage Procedure Disposal Procedure(Consider residual of substances in containers)

4 It is current safety policy that a written COSHH assessment must be provided when a substance to be used has been assigned any of the risk phrases R42, R43, R45, R46, R48, R49, R60 or R61. Other hazards may also dictate the preparation of a suitable COSHH assessment.

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