COSHH ASSESSMENT FORM

LOCATION: NWH ASSESSMENT REF: 13496 DEPARTMENT: FIRE TEAM DATE COMPLETED: 16/6/96

DESCRIPTION OF SUBSTANCE USE AND LIST TASKS:

STD MONEX DRY POWDER USED BY FIRE TEAM OR OTHERS FOR FIREFIGHTING

HAZARD
SUBSTANCES (Included Impurities) Potassium salt urea based LIST OF TASKS 1 Physical Form HAZARDS TO HEALTH Practically non harmful , slight skin & eye irritant

RISK-POTENTIAL FOR EXPOSURE High, Med, or Low Refer to EH40 Book

Inhale Ingest skin

EXPOSURE LIMITS (MEL/OES) ppm / mg/m3 10mg/m3 OEL

SK / SEN

sk

EXPOSURE POTENTIAL
WHO IS EXPOSED FIRE TEAM OR OTHERS DURATION (Minutes/Hours) NOT KNOWN
VARIOUS

FREQUENCY (Weekly, Monthly, Annual) WHEN REQUIRED

QUANTITY USED METHOD OF STORAGE

N/A

Kgs or Litres etc (approx.)

IN FIRE EXTINGUISHERS OR SEALED CONTAINERS

METHOD OF STORING WASTE CONTROL MEASURES (Procedural, Engineering & Personal Protective Equipment)

PROCEDURAL
PROCEDURE No. PERMIT OTHER 1

NO

YES / NO NO

ENGINEERING
LOCATION Inside/Outside/Confined Space INSIDE/OUTSIDE VENTILATION Natural/Local Exhaust/Forced NATURAL/LOCAL EXHAUST EFFECTIVENESS High/Medium/Low HIGH

PERSONAL PROTECTIVE EQUIPMENT (Specify Protection & Facilities In Addition To Site Minimum)
TYPE RESPIRATORY PROTECTION GLOVES MINIMUM SAFETY GLASSES, SAFETY GLASSES/VISOR/GOGGLES OTHER: YES COVERALLS N/A PVC SUITS N/A SPLASH SHIELD WELFARE/WASHING FACILITIES EQUIPMENT DUST MASK FOR EXTINGUISHER REFILL YES

EMERGENCY RESPONSE
FORESEEABLE INCIDENTS (e.g. Spillage)
INCIDENT NONE FORESEEABLE ARE THE FOLLOWING AVAILABLE WRITTEN PLANS EQUIPMENT FACILITIES

FIRST AID MEASURES

CONTACT WITH EYES CONTACT WITH SKIN BY INHALATION BY INGESTION WASH WITH PLENTY WATER - INFORM MEDIC WASH OFF SKIN NON TOXIC AS ABOVE

MONITORING (Results of any previous Surveys)

NONE

CONCLUSION
RISK SIGNIFICANT RISK NOT SIGNIFICANT DUE TO EFFECTIVE CONTROL MEASURES RISKS NOT SIGNIFICANT

YES

FURTHER ACTION
CONSIDER THE FOLLOWING OPTIONS 1. Can the activity be avoided by;a. Elimination ? b. Substitution for a safer substance ? (State the substituted substance) c. Using it in a safer form ? d. Total enclosure ? YES NO DATE COMPLETED

* * * *

e. Partial enclosure ? f. Modifying existing procedure ? 2. 3. 4. 5. 6. Can the general ventilation be improved ? Are procedures needed for maintenance examination and test of control measures ( RPE, etc.) ? Is there a need for additional health surveillance ? Is there a need for further air monitoring ? Is there a need for information, instruction and training?

* * * * * * *

DETAILS / COMMENTS

(Please give details of the actions taken and the person responsible in particular if answer was YES to any of the above questions).

Date of Next Assessment Review Signature of Assessor Position

16/6/2001
Name

W RICHMOND

SAFETY OFFICER