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FORM_COSHH_01 — Simple COSHH Assessment Form

Document Information

Field Value
Document Reference FORM_COSHH_01
Issue Number 1
Issue Date 1 October 2026
Next Review 1 October 2027
Controlled By Sean Ashton (HSQE Consultant)
Approved By Aaron Mason, Director

The blank behind the thirty

Download FORM_COSHH_01 (.docx)

This is the sixteen-section format every assessment on APP_09 uses. COSHH_25–30 were issued in it on 08/09/2026 and COSHH_01–24 migrated to it on 09/09/2026.

Before you start

You need the safety data sheet and the container in front of you. The SDS gives the classification and the exposure limits; the container tells you what is actually held, in what quantity, and whether the label matches the sheet. An assessment written from the SDS alone records a product rather than a use, and COSHH Regulation 6 is about the use.
Next free reference Take it from APP_09 — do not reuse a withdrawn one
Where the SDS goes Save a copy to docs/coshh/sds/. A supplier link is not enough on its own: suppliers move files
Who signs Assessor, Supervisor, Director. The user acknowledges on issue
How long it takes About twenty minutes with the sheet and the container to hand

1. Product identification
Product name
Supplier
Active ingredients / CAS
Physical form
Appearance / odour
Use What it is used for at AMWS, on which task
Location Which cabinet, which van, which unit
Quantity held The assessment covers the quantity stated. A 5 l assessment does not cover a 200 l drum

2. Hazard classification

Signal word: Danger ☐ Warning ☐ None ☐

GHS pictograms: GHS01 ☐ GHS02 ☐ GHS03 ☐ GHS04 ☐ GHS05 ☐ GHS06 ☐ GHS07 ☐ GHS08 ☐ GHS09 ☐

H-code Statement
P-code Statement

Read from the container label and confirmed against the SDS. Where the two differ, record both and say which was used.

3. Persons at risk

Staff Public Visitors Contractor Workers Young / Pregnant
☐ ☐ ☐ ☐ ☐ ☐

4. Routes of exposure

  • Inhalation:
  • Skin contact:
  • Eye contact:
  • Ingestion:

Say which route is the significant one for this product and this task, not all four equally.

5. Workplace exposure limits (HSE EH40/2005)

Component STD 8-hr TWA 15-min STEL Notes

If no component has a WEL, say so. "None assigned" is an answer; a blank table is not.

6. Frequency and duration of exposure

COSHH Regulation 6 requires the assessment to consider the amount, the level and the duration of exposure.

Amount used Times per day Duration per use

7. Control measures — hierarchy of controls

Level Control Applied
Eliminate ☐
Substitute ☐
Engineering ventilation, bunding, closed transfer ☐
Administrative procedure, training, restricted access, signage ☐
PPE the actual gloves, goggles or RPE — name them, by type ☐

PPE is last and it is never the whole answer. Name the glove material, not "gloves".

8. Storage and handling
Temperature
Location
Avoid incompatible materials
Container

9. Emergency procedures

First aid
Eyes
Skin
Inhalation
Ingestion

Spillage

Fire — suitable extinguishing media, and what not to use:

10. Waste disposal

Waste stream, carrier, and whether a hazardous waste consignment note is required.

11. Risk rating

Before controls With controls

Risk rating methodology: Severity × Likelihood = Risk (S × L = R). See POL_HSQE_21 — Risk Assessment for the full scoring matrix.

12. Training requirements

-

Regulation 12 requires users to be informed, instructed and trained. Name what they need, so it can be put on APP_12.

13. Assessment outcome

Outcome
Safe to proceed with existing control measures ☐
Safe to proceed with additional actions ☐
Unsafe — do not proceed ☐

If additional actions, list them with an owner and a date.

# Action Owner Target
1
2

14. Monitoring and review

  • Monthly cabinet check on FORM_COSHH_CAB_01
  • Audit against this assessment under APP_26, on the frequency set for its hazard group
  • Annual review, or sooner on change of product, supplier or task
  • Review immediately if the SDS obtained differs from the profile assumed above

15. References

16. Signatures

Name Signature Date
Assessor
Supervisor
Approved by Aaron Mason, Director
User acknowledgement

After the assessment

  1. Add the row to APP_09 — reference, substance, signal word, location.
  2. Save the SDS to docs/coshh/sds/ and link it from the assessment.
  3. If the substance is carried in the van packs, mark it so, and it syncs to the Van Packs portal.
  4. If section 13 carried actions, they are tracked to their dates and the assessment is reissued when they close.
  5. If it is a hazard group that needs an early audit, schedule the first one on APP_26.

Audit trail

Issue Date Approved By Summary
1 01/10/2026 Aaron Mason, Director Initial issue. The blank of the sixteen-section format adopted on 08/09/2026 and applied across the register on 09/09/2026, published so a new substance can be assessed without working backwards from an existing assessment. Carries the reference already held for it at APP_24. Issued following a query from the Finance & Compliance Assistant on 01/10/2026.