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 — Acrypol Roof Coating (Acrylic Polymer / Hydrocarbon Solvent)

This pre-completed COSHH assessment covers Acrypol roof coating — an acrylic polymer emulsion or solvent-borne coating used for waterproofing, patching and protecting flat and pitched roofing surfaces. Solvent-based formulations are flammable and require adequate ventilation.

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 (Acrypol Roof Coating), chemical name (acrylic polymer in hydrocarbon solvent carrier), SDS reference and physical state
• Health effects and first aid — inhalation of vapour/mist causing respiratory irritation and drowsiness; ingestion with aspiration pneumonia risk; skin irritation; serious eye irritation; specific first aid for each route
• Flammable solvent hazard — solvent-based formulations are flammable; keep away from all ignition sources during application and drying; do not use in enclosed spaces without LEV
• Workplace exposure limits — hydrocarbon solvent (white spirit/naphtha) TWA 575 mg/m³ over 8 hours, from workplace exposure limits guidance
• CLP hazard classification — Flammable, Irritant and Environmental pictograms
• PPE requirements — including safety goggles, nitrile or PVC gloves, coveralls and full face shield for spray application
• Emergency procedures — spillage: eliminate ignition sources, absorb with inert material; fire: use foam or CO2

Who Is This COSHH Assessment For?

This assessment is suitable for any workplace where Acrypol or similar solvent-based roof coatings are used, including:

• Roofing contractors and flat roof specialists
• Building maintenance and facilities management teams
• Construction contractors undertaking waterproofing works
• Property management companies with flat roof maintenance

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.