ARCHIRODON GROUP NV Integrated Management System

Health, Safety & Environment (HSE) Rev. Issued For General Use Reference No. HSE-PRO-01-F01 Serial No. Page 1 of 1

FORM COSHH Assessment

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1. Product or Operation:

2. Manufacturer:

3. Flash Point:

4. Occupational Exposure Limit: 7. Method of Application 8. Hazards:

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5. Exposure Time:

6. Area to be used:

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9. Health Effects:

10. Control Measure in Place or Required:

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11. First Aid Requirements:

12. Emergency Response:

13. Storage Instructions:

14. Waste Management:

15. Other Information:

Completed by
Job Position Name Surname Signature Date

Approved by
Job Position Name Surname Signature Date HSE Manager

Distribution List
Job Position HSE Manager Foreman Name Surname