Assessment reference number and date of assessment
Name and job title of the person carrying out the assessment
Substance name, trade name, and Safety Data Sheet (SDS) reference number and revision date
Hazard classification: GHS/CLP hazard categories, signal word (Danger or Warning), and relevant H-statements (e.g. H334 May cause allergy or asthma symptoms if inhaled)
Workplace Exposure Limit (WEL): state the 8-hour time-weighted average (LTEL) and 15-minute short-term (STEL) values from EH40/2005 Table 1, or confirm no WEL applies
Who is exposed: job roles, number of people, and whether any are particularly vulnerable (new or expectant mothers, young workers, workers with pre-existing conditions)
All checks done
Safety
COSHH Assessment Form
A COSHH Assessment Form is the written record an employer must complete before work begins with any substance hazardous to health, as required by Regulation 6 of the Control of Substances Hazardous to Health Regulations 2002. Without it, the HSE can issue an improvement or prohibition notice, pursue an unlimited fine, and publish the breach on its public enforcement register for five years.
12 checksPDF + printReviewed August 2026
Built on published UK guidance Show sources
Control of Substances Hazardous to Health Regulations 2002 (SI 2002/2677) Regulations 6, 7, 9, 10, 11; COSHH Approved Code of Practice and Guidance L5 (sixth edition, HSE); EH40/2005 Workplace Exposure Limits (fourth edition, 2020) Table 1; Health and Safety at Work etc. Act 1974 s.21 (improvement notices), s.22 (prohibition notices)
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What’s on it
12 things to check.
Everything that matters, nothing that does not. Here is the full list, exactly as it appears on the template.
1Assessment reference number and date of assessment
2Name and job title of the person carrying out the assessment
3Substance name, trade name, and Safety Data Sheet (SDS) reference number and revision date
4Hazard classification: GHS/CLP hazard categories, signal word (Danger or Warning), and relevant H-statements (e.g. H334 May cause allergy or asthma symptoms if inhaled)
5Workplace Exposure Limit (WEL): state the 8-hour time-weighted average (LTEL) and 15-minute short-term (STEL) values from EH40/2005 Table 1, or confirm no WEL applies
6Who is exposed: job roles, number of people, and whether any are particularly vulnerable (new or expectant mothers, young workers, workers with pre-existing conditions)
7Routes of exposure and estimated duration and frequency (e.g. inhalation during spray application, 30 minutes per day, three days per week)
8Control measures in place, listed in hierarchy order: elimination or substitution considered first, then engineering controls (e.g. LEV, enclosure), then administrative controls (e.g. reduced exposure time, safe system of work), and finally PPE as last resort only
9Personal protective equipment required: type, standard (e.g. RPE to EN 149:2001+A1, nitrile gloves to EN 374), fit-check or face-fit test requirement, and storage/disposal instructions
10Health surveillance requirement: state yes or no, the basis for the decision under Regulation 11, and if yes the name of the competent person responsible and the frequency of checks
11Emergency arrangements: first aid measures for skin/eye contact, inhalation, ingestion; spill procedure; and location of SDS for emergency services
12Date of next scheduled review and the name and signature of the responsible manager confirming the assessment is suitable and sufficient
Good to know
Regulation 6(4) of the COSHH Regulations 2002 requires employers with five or more employees to record the assessment in writing. Health surveillance records created under Regulation 11 must be retained for at least 40 years from the date of the last entry, because many occupational diseases linked to hazardous substances, such as occupational asthma and nasal cancer from hardwood dust, have very long latency periods.
Source: Control of Substances Hazardous to Health Regulations 2002 (SI 2002/2677) Regulations 6, 7, 9, 10, 11; COSHH Approved Code of Practice and Guidance L5 (sixth edition, HSE); EH40/2005 Workplace Exposure Limits (fourth edition, 2020) Table 1; Health and Safety at Work etc. Act 1974 s.21 (improvement notices), s.22 (prohibition notices)
Good to know
Questions, answered
What is the COSHH Assessment Form?
A COSHH Assessment Form is the written record an employer must complete before work begins with any substance hazardous to health, as required by Regulation 6 of the Control of Substances Hazardous to Health Regulations 2002. Without it, the HSE can issue an improvement or prohibition notice, pursue an unlimited fine, and publish the breach on its public enforcement register for five years.
Why does it matter?
Regulation 6(4) of the COSHH Regulations 2002 requires employers with five or more employees to record the assessment in writing. Health surveillance records created under Regulation 11 must be retained for at least 40 years from the date of the last entry, because many occupational diseases linked to hazardous substances, such as occupational asthma and nasal cancer from hardwood dust, have very long latency periods.
How do I get it, and is it up to date?
The PDF downloads the moment you check out, prints sharp in black and white, and opens on any phone. It is reviewed for August 2026 and you get any future update free when the official guidance changes.
A discharged or depressurised extinguisher found during a real fire is no better than having no extinguisher at all. The monthly visual check catches the common pre-failure states (lost pressure, broken tamper seal, blocked access, overdue service) before they matter, and it gives the responsible person the maintenance records the Regulatory Reform (Fire Safety) Order 2005 requires.
A fire door only works if it closes fully, latches, and seals the gaps; one door that fails to do that lets smoke and fire spread through a building in minutes and removes people's time to escape. These checks catch the specific, common failures (props, blown gaps, missing closers, painted-up seals) that turn a survivable fire into a fatal one.
An under-stocked or expired first aid kit means the person treating an injury reaches for a dressing and finds an empty slot, a perished wrapper, or latex gloves that trigger an allergic reaction. A regular documented check fixes that in advance and gives an HSE or Ofsted inspector evidence that your first aid provision is genuinely maintained, not just present.