Coshh Assessment Form
Coshh Assessment Form
Coshh Assessment Form
LOCATION: NWH ASSESSMENT REF: 13496 DEPARTMENT: FIRE TEAM DATE COMPLETED: 16/6/96
HAZARD
SUBSTANCES (Included Impurities) Potassium salt urea based LIST OF TASKS 1 Physical Form HAZARDS TO HEALTH Practically non harmful , slight skin & eye irritant
SK / SEN
sk
EXPOSURE POTENTIAL
WHO IS EXPOSED FIRE TEAM OR OTHERS DURATION (Minutes/Hours) NOT KNOWN
VARIOUS
METHOD OF STORING WASTE CONTROL MEASURES (Procedural, Engineering & Personal Protective Equipment)
PROCEDURAL
PROCEDURE No. PERMIT OTHER 1
NO
YES / NO NO
ENGINEERING
LOCATION Inside/Outside/Confined Space INSIDE/OUTSIDE VENTILATION Natural/Local Exhaust/Forced NATURAL/LOCAL EXHAUST EFFECTIVENESS High/Medium/Low HIGH
PERSONAL PROTECTIVE EQUIPMENT (Specify Protection & Facilities In Addition To Site Minimum)
TYPE RESPIRATORY PROTECTION GLOVES MINIMUM SAFETY GLASSES, SAFETY GLASSES/VISOR/GOGGLES OTHER: YES COVERALLS N/A PVC SUITS N/A SPLASH SHIELD WELFARE/WASHING FACILITIES EQUIPMENT DUST MASK FOR EXTINGUISHER REFILL YES
EMERGENCY RESPONSE
FORESEEABLE INCIDENTS (e.g. Spillage)
INCIDENT NONE FORESEEABLE ARE THE FOLLOWING AVAILABLE WRITTEN PLANS EQUIPMENT FACILITIES
CONCLUSION
RISK SIGNIFICANT RISK NOT SIGNIFICANT DUE TO EFFECTIVE CONTROL MEASURES RISKS NOT SIGNIFICANT
YES
FURTHER ACTION
CONSIDER THE FOLLOWING OPTIONS 1. Can the activity be avoided by;a. Elimination ? b. Substitution for a safer substance ? (State the substituted substance) c. Using it in a safer form ? d. Total enclosure ? YES NO DATE COMPLETED
* * * *
e. Partial enclosure ? f. Modifying existing procedure ? 2. 3. 4. 5. 6. Can the general ventilation be improved ? Are procedures needed for maintenance examination and test of control measures ( RPE, etc.) ? Is there a need for additional health surveillance ? Is there a need for further air monitoring ? Is there a need for information, instruction and training?
* * * * * * *
DETAILS / COMMENTS
(Please give details of the actions taken and the person responsible in particular if answer was YES to any of the above questions).
16/6/2001
Name
W RICHMOND
SAFETY OFFICER