Coshh Risk Assessment Sample Form

COSHH RISK ASSESSMENT FORM
Location:
Task:
Task Length:
Substance(s) Involved
Hazards Identified with substance(s), and exposure to substances
Category of substance(s) (please circle)
Very toxic Toxic Corrosive Irritant Harmful
Carcinogen/Teratogen/Mutagen
Risk Rating (please circle) Low Medium High
Low risk: exposure unlikely to cause health problems but if it did would be
such as to be easily treated with no lasting effects.
Medium risk: exposure may have acute effects which may have lasting
effects.
High risk: exposure may have chronic effects or could result in death.
Precautions to be Taken (including PPE)
a. under normal circumstances
b. in an emergency (e.g. following a
spillage)
First Aid Treatment
Fire Fighting
Assessed by:
Position:
Signed:
Date:
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Coshh Risk Assessment Sample Form PDF

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