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 — Diacetyl (Butane-2,3-dione — Butter Flavouring)

This pre-completed COSHH assessment covers diacetyl (butane-2,3-dione) — a yellow-green flammable liquid with an intense butter/caramel odour, used as a flavouring agent in food and beverage manufacturing. Diacetyl is the primary cause of obliterative bronchiolitis ('popcorn lung') — a severe, irreversible and potentially fatal obstructive lung disease caused by occupational inhalation. LEV is mandatory and health surveillance including lung function testing is required.

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 (Diacetyl / butane-2,3-dione), chemical name and physical state (yellow-green liquid; intense butter odour; flammable, flash point ~27°C; highly volatile)
• Health effects and first aid — inhalation causing obliterative bronchiolitis (permanent, potentially fatal lung scarring); ingestion, skin sensitisation and serious eye irritation; immediate medical assessment required after any significant inhalation exposure
• Obliterative bronchiolitis — permanent lung damage — even brief elevated exposures can cause irreversible obstructive lung disease; symptoms may not appear until years after exposure; health surveillance with lung function testing is required for regularly exposed workers
• Workplace exposure limits — STEL 0.1 ppm (0.36 mg/m³) over 15 minutes; EU indicative TWA 0.02 ppm (0.07 mg/m³); extremely low limits reflecting the severe chronic lung disease risk; LEV essential
• CLP hazard classification — Toxic, Flammable and Long-term health hazard pictograms
• PPE requirements — including safety goggles, nitrile gloves, coveralls, chemical-resistant footwear; LEV as primary control; organic vapour/P2 filter RPE where LEV is insufficient
• Emergency procedures — significant release: evacuate, eliminate ignition sources, ensure ventilation before re-entry; spillage: avoid all vapour contact

Who Is This COSHH Assessment For?

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

• Food flavouring manufacturing and blending operations
• Snack food and popcorn production facilities
• Bakery and dairy product flavouring applications
• E-liquid and vaping product manufacturing

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.