COSHH Assessment Form

EHSMS Formats
Ref: SP 6.1.2-7 Rev 00 Page 1 of 5

COSHH Assessment Form

This assessment only addresses the risk of harm to health from the substances listed.
Additional risk assessments may be required to control the risk from other hazards associated
with this work/the procedures used.
Assessor (print) (1)
Project Manager (2)

Mr. V. MURUGANANTHAM – DGM EHS [Link] G Mahajan – PD

Assessment Date (3)

Dates reviewed(4)
10-Apr 2023 10-Apr 2023

HAZARDS IDENTIFIED
Toxic/ harmful/ irritant/ sensitizer/ carcinogenic etc..

Substance(5) How the harm will occur(6) Quantity(7)

(Name of Chemical, etc. as (Provide details of how the substance (Indicate how much of
appropriate); NB. could cause harm, e.g. harmful by the substance will be
inhalation, skin contact, ingestion, etc) used)
Diesel Inhalation, skin contact

Hazards and precautionary statements : Long-term exposure may cause dermatitis

(itching, irritation, pain and swelling). Inhalation may cause irritation and significant or long term
exposure could cause respiratory insufficiency and pulmonary edema. Ingestion may cause
aspiration, gastrointestinal.

 Keep away from heat/sparks/open flames/hot surfaces. – No smoking.

 Keep container tightly closed.
 Ground/bond container and receiving equipm
 Use explosion-proof electrical/ventilating/lighting//equipment.
 Use only non-sparking tools.
 Take precautionary measures against static discharge.
 Wear protective gloves/protective clothing/eye protection/face
protection.
 IF ON SKIN (or hair): Remove/Take off immediately all
 contaminated clothing. Rinse skin with water/shower.
 In case of fire: Use for extinction.
 Store in a well-ventilated place. Keep cool.
 Dispose of contents/container to

Emergency First aid Procedures(8)

 Eye contact : Immediately flush with large amount of water for at least 15 min holding
lids apart to ensure flushing of the entire eye surface. Seek immediate medical attention.
 Inhalation : Remove exposed person to fresh air
 Skin contact : Wash contaminated areas with plenty of soap & water. A soothing
ointment may be applied to irritated skin after thoroughly cleaning. Seek immediate medical
attention.
 Ingestion : NA
Spill procedure : Using Proper hose & funnel to avoid spill.

Sensitivity: LNT Construction Internal Use

 COSHH Assessment Form
EHSMS Formats
Ref: SP 6.1.2-7 Rev 00 Page 2 of 5

Fire fighting measures (in case of flammable and combustible materials):

What will the chemical be used for? (insert the activities/ process/location for which this
will be used) Who may be exposed? (9)

Activities: Feeding into compressor,vehicle & pumps

Location: Site

Exposing to : Drivers,Operators & helpers

METHODS OF PREVENTION OR CONTROL OF EXPOSURE

(select all that apply by circling/ticking/highlighting the appropriate statement)

1. Engineering controls required(10) 2. Access control(11)

 Total containment  Restricted to competent personnel
 Fume cupboard  Special containment facility (give specific area):
 Local exhaust ventilation 
General ventilation
3. Special procedures(12) 4. Approved PPE(13) ( Note: PPE is to be used as
the ‘last resort’ when controlling exposure)
 Standard Operating Procedure (SOP) required
 Code of practice, local rules, etc  Gloves etc. (Rubber gloves)
 Eye protection (Googles)
 Laboratory coat/overalls (specify type)
 Respiratory protection (Nose mask)
 Other PPE (specify)

Disposal Procedures(14) (Give details of waste disposal procedure to be used)

Are chemicals with hazard statements H400 – H413* (environmental hazards) involved?
Yes / No

TRAINING REQUIREMENTS(15)
(List any specialised training requirements before work can begin)

 On the job training

 Special training on occupation health hazards & its prevention

HANDLING AND STORAGE REQUIREMENTS(16)

Stored in approved container, drums. Protect drums from physical damage. Outside or
detached storage is preferred. Separate from oxidizing materials. Store in cool, well ventilated
area of non-combustible construction away from possible sources of ignition. Keep fire
extinguisher near the storage area.

ASSESSMENT OF RISK USING CONTROLS DETAILED ABOVE(17)

(Are the hazards/risks suitably controlled, using the control measures detailed above? If not,
state the further actions required, e.g. Requirement for a standard operating procedure (SOP),
etc).

Sensitivity: LNT Construction Internal Use

 COSHH Assessment Form
EHSMS Formats
Ref: SP 6.1.2-7 Rev 00 Page 3 of 5

Authorisation by Project Manager/ Construction Manager18

I confirm that I have considered and understand the chemical to be used and the
associated hazards. I am satisfied that all of the hazards have been identified and that
the control measures to be followed will reduce the risks to as low a level as
reasonably practicable.

Print name: Signed:

Date: 10-Apr 2023

Guidance notes for COSHH assessment form

This form must be completed for every hazardous chemical used within the company. The form
must be signed by the employee and their employer/supervisor before the work starts.

(1) Assessor: Insert the name of the person doing this assessment (usually the
concerned site engineer, who is likely to be using the hazardous substance or the
EHSO)

(2) Project Manager Insert the name of the Project Manager.

(3) Assessment Date: Insert the date that the assessment form is completed. It must be
reviewed when there is a significant change occurs (revision in the SDS, substance
received from another supplier/ manufacturer, etc).

(4) Dates reviewed: all COSHH assessments must be reviewed annually (as a minimum).
The review date should be entered here, and signed by the assessor to confirm that
the assessment is still valid.

(5) Substance: insert name of the chemical to be used. NB. Biological hazards must not
be assessed on this COSHH form.

(6) How the harm will occur: insert details of the route of entry into the body -
inhalation, absorption, ingestion, eye contact etc).

(7) Quantity: insert quantity to be used (mg, g, ml, etc)

(8) Emergency first aid procedures: provide full details of emergency procedures to be
employed following contact with the chemical (skin contact, eye contact, inhalation
and ingestion) – such as use of diphoterine, administration of emergency oxygen, etc.
Also include details of emergency spill procedures.

Sensitivity: LNT Construction Internal Use

 COSHH Assessment Form
EHSMS Formats
Ref: SP 6.1.2-7 Rev 00 Page 4 of 5

(9) What will the chemical be used for? Who may be exposed? : Insert the activity/
process/ location in which the chemical is to be used in, and detail who may be
exposed (individual worker? People in close proximity? Cleaners? Engineers?).

Methods of prevention or control of exposure

Sections 11-14 detail the methods for preventing or controlling exposure to the chemical. The
COSHH hierarchy of control measures should be used when determining the methods to be used to
prevent/control exposure, with engineering and group control measures being employed in
preference to individual measures (such as individual PPE).

(10) Engineering controls required: identify the control measures necessary to

prevent/control exposure, such as use of a fume cupboard, LEV or blast screen, by
circling/ticking/highlighting the appropriate statement(s).

(11) Access control: In order to prevent/control exposure, is it necessary to restrict access

to competent personnel? Are special containment facilities required? Please
circle/tick/highlight the appropriate statement(s).

(12) Special procedures: please identify any special procedures necessary to

prevent/control exposure. This might include the need for an SOP to be developed, or
for local rules to be drawn up. Please circle/tick/highlight the appropriate statement(s).

(13) Approved PPE: PPE is to be used as the ‘last resort’ when preventing/ controlling
exposure. Please detail the PPE to be used when handling the chemical. Please
circle/tick/highlight the appropriate statement(s) and include details of the type of
gloves, etc to be used.

(14) Disposal procedures: Identify whether the chemical is an environmental hazard;

Detail fully how the chemical waste is to be disposed of (down sink, by specialist
contractor, etc)

(15) Training requirements: detail any specialised training requirements that must be
met before the work can begin – eg. Attendance on a gas safety course, etc).

(16) Handling and storage requirements: Note any special requirements e.g.
ventilation, chemical incompatibility, flash point, etc.

(17) Assessment of risk using controls detailed above: Are the hazards/risks suitably
controlled, using the control measures detailed above? Provide details; If not
controlled, state the further actions required, eg. Requirement for a standard operating
procedure (SOP), etc.

(18) Authorisation by Project Manager/ Construction Manager: the PM/ CM

must sign and date the assessment, to confirm that they have considered and
understand the chemical to be used and the associated hazards, and that they are
satisfied that all of the hazards have been identified and that the control measures to
be followed will reduce the risks to as low a level as reasonably practicable.

Sensitivity: LNT Construction Internal Use

 COSHH Assessment Form
EHSMS Formats
Ref: SP 6.1.2-7 Rev 00 Page 5 of 5

Sensitivity: LNT Construction Internal Use