Generating form. Please wait...

Control Of Substances Hazardous To Health Regulations 1994
Risk Assessment Form
Hazard Reference Number
Task / Activity
Chemical / Substance
Category
Irritant
Harmful
Flammable
Corrosive
Extremely Flammable
Explosive
Toxic
Highly Flammable
Oxidising
Persons At Risk
Client
Contractor
Member of public
Employee
Visitor
Worst Case Effect
Fatality
Irreversible effect
Reversible effect
Minimal effect
No effect
Likelihood
Likely/frequent (occurs repeatedly/event to be expected)
Probable (not surprised, will occur several times)
Possible (could occur sometimes)
Remote (unlikely though conceivable)
Improbable (probability close to zero)
Risk
New / Expectant Mothers
Does this activity constitute an unacceptable risk to new or expectant mothers?
Yes
No
If yes state what action is required
Control Measures
Existing Controls
 
Adequate
Further ControlsDeadline
  
Accidents & Emergencies
SkinEyesInhalationIngestion
    
Disposal (This information is available on the supplier's data sheet)
Chemical / SubstanceClothing
  
Assessor's Name
Assessment Date
Signature
Review Date
Assessor's Job Title