Effective form templates

This example COSHH risk assessment has been prepared using the
F-HS5 COSHH Assessment form template which has been designed to record and manage the risks associated with substances hazardous to health and includes:

• Substance details
• Physical description
• Health effects and first aid
• Workplace exposure limits (WELs)
• CLP hazard classification — visual hazard icons
• Risk rating
• Control measures
• PPE required — visual PPE icons
• Environmental considerations

The file is supplied in fully editable MS Word format and can be easily customised and saved to Google Docs format if required. The document uses pre-defined style formatting throughout with styles to match the risk-ratings. All text is in Calibri font for improved readability.
The following document labelling is included in the footer:

• Form number and title
• Information-classification
• Version
• Page number / total pages

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COSHH Assessment — Asphalt (Bitumen / Mineral Aggregate — Hot and Cold Mix)

This pre-completed COSHH assessment covers asphalt — a mixture of bitumen binder and mineral aggregates used in road surfacing, car parks and paving. Hot mix asphalt is applied at 130–160°C generating bitumen fumes; aggregates may contain respirable crystalline silica (RCS). Both are significant occupational health hazards requiring LEV and RPE.

What Does This COSHH Assessment Cover?

The assessment is fully completed and ready to use, covering all sections required for a complete hazardous substance risk assessment:

• Substance identification — trade name (Asphalt / Hot Mix and Cold Mix), chemical name (bitumen with mineral aggregates; may contain RCS), SDS reference and physical state
• Health effects and first aid — bitumen fume inhalation; severe thermal burns from hot material; RCS dust inhalation; specific emergency first aid for each route
• Carcinogen — bitumen fume and RCS — bitumen fumes are a probable carcinogen (IARC Group 2A); aggregate dust may contain RCS (Group 1 carcinogen); health surveillance recommended for regularly exposed workers
• Workplace exposure limits — bitumen fume TWA 0.5 mg/m³; RCS TWA 0.1 mg/m³, from workplace exposure limits guidance
• CLP hazard classification — Irritant and Long-term health hazard pictograms
• PPE requirements — including RPE, heat-resistant gloves, eye protection, coveralls and safety boots for hot work
• Emergency procedures — hot burns: cool with water, do not remove adhered asphalt; fire: use CO2 or foam

Who Is This COSHH Assessment For?

This assessment is suitable for any workplace where asphalt is handled, including:

• Highways and road surfacing contractors
• Car park and paving construction businesses
• Local authority highways maintenance teams
• Civil engineering and infrastructure contractors

COSHH Compliance

This document provides ready-to-use evidence of COSHH compliance and supports occupational health and safety management. The assessment is based on the F-HS5 COSHH Assessment template, is fully editable in Microsoft Word, and can be customised with your company details, site-specific information and review dates.