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 — PU Adhesive (Dichloromethane / MDI Polyurethane)

This pre-completed COSHH assessment covers polyurethane adhesive containing dichloromethane (DCM) as solvent carrier and diphenylmethane diisocyanate (MDI) as reactive component — including products such as Castle Composites PU Adhesive. Used in construction and manufacturing for bonding stone, composite and panel materials.

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 (PU Adhesive / Castle Composites), chemical name (DCM solvent with MDI reactive component), SDS reference and physical state
• Health effects and first aid — inhalation, ingestion, skin contact and eye contact, with specific first aid for each route including emergency medical attention for DCM/MDI exposure
• Dual carcinogen and sensitiser hazard — DCM is a probable carcinogen (IARC Group 2A) metabolised to CO in the body posing cardiac risk; MDI is a respiratory sensitiser causing permanent occupational asthma; LEV is essential
• Workplace exposure limits — DCM TWA 100 ppm and STEL 300 ppm; MDI TWA 0.02 mg/m³ (very low due to sensitisation risk), from workplace exposure limits guidance
• CLP hazard classification — Irritant and Long-term health hazard pictograms
• PPE requirements — including nitrile gloves, eye protection, and RPE with organic vapour/P2 filter; LEV at point of use
• Emergency procedures — spillage in well-ventilated area; fire: not classified flammable

Who Is This COSHH Assessment For?

This assessment is suitable for any workplace where DCM/MDI PU adhesive is used, including:

• Stone cladding and composite panel installers
• Construction contractors using structural adhesives
• Kitchen and bathroom fitting operations
• Manufacturing facilities bonding composite materials

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.