COSHH Assessment Form
Product name & Manufacturer
Stored
Storage Instructions
Fire Fighting Measures
Process/use information
Where is Product used
When is product used
Identify the persons at risk:	Employees	Contractors	Students
Classification (state the category of danger)
Extremely Flammable Toxic Irritant Very Toxic Highly Flammable Sensitising Flammable Biological Corrosive Environmental Oxidising Harmful
Hazard Type
Gas Vapour Mist Fume Dust Liquid Solid Other (State)
Route of Exposure
Inhalation Skin Eyes Ingestion Other (State)
Control Measures: (for example extraction, ventilation, training, supervision). Include special measures for vulnerable groups, such as disabled people and pregnant workers. Take account of those substances that are produced from activities undertaken by another employer’s employees.
See Safety Data sheet for more information
Personal Protective Equipment (state type and standard)
Dust mask	Visor
Respirator	Goggles
Gloves	Overalls
Footwear	Other
First Aid Measures
Ingestion
Skin
Eyes
Inhalation
Is exposure adequately controlled?	Yes No

Assessed by:	Position:	Date: