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 — Lithomex (Natural Hydraulic Lime Mortar / NHL with RCS)

This pre-completed COSHH assessment covers Lithomex — a natural hydraulic lime (NHL) mortar product containing calcium silicates, calcium hydroxide and respirable crystalline silica (RCS) as a natural impurity. Used in heritage conservation, masonry repair and stone building work. Strongly alkaline when wet; LEV and RPE are required for dusty operations.

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 (Lithomex Natural Hydraulic Lime Mortar), chemical name (NHL; calcium silicates and calcium hydroxide with RCS impurity), SDS reference and physical state
• Health effects and first aid — dust irritating airways; ingestion causing alkaline burns; wet product causing progressive skin burns; severe eye chemical burns; specific first aid for each route
• Silicosis and carcinogen risk — contains RCS (Group 1 carcinogen); inhalation causes silicosis (irreversible progressive lung disease) and lung cancer; health surveillance required for regularly exposed workers; LEV essential
• Workplace exposure limits — calcium hydroxide TWA 5 mg/m³; RCS TWA 0.1 mg/m³ over 8 hours, from workplace exposure limits guidance
• CLP hazard classification — Irritant and Corrosive pictograms
• PPE requirements — including safety goggles, PVC or neoprene gloves, coveralls and FFP2/FFP3 respirator for dusty work
• Emergency procedures — dry spill: vacuum or wet methods; wet spill: contain and absorb with inert material

Who Is This COSHH Assessment For?

This assessment is suitable for any workplace where Lithomex or similar NHL mortars are used, including:

• Heritage conservation and listed building contractors
• Stonemasonry and traditional building specialists
• Architects and contractors on conservation projects
• Restoration and refurbishment specialists

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.