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 — Tile Grout (Cement-Based / Portland Cement with Cr VI)

This pre-completed COSHH assessment covers cement-based tile grout — a Portland cement and fine aggregate blend with polymer modifiers used for filling joints between tiles. Contains trace hexavalent chromium (Cr VI) and may contain respirable crystalline silica (RCS). Strongly alkaline when wet.

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 (Cement-Based Tile Grout), chemical name (Portland cement, fine aggregate, polymer modifiers; trace Cr VI and RCS), SDS reference and physical state
• Health effects and first aid — dust causing respiratory irritation and silicosis risk; wet grout causing alkaline skin burns and serious eye damage; Cr VI causing allergic contact dermatitis; specific first aid for each route
• Silica carcinogen and chromium sensitiser — RCS (where present) is a Group 1 carcinogen; Cr VI is a skin sensitiser; health surveillance required for regularly exposed workers
• Workplace exposure limits — cement dust TWA 4 mg/m³; RCS TWA 0.1 mg/m³; Cr VI TWA 0.01 mg/m³, from workplace exposure limits guidance
• CLP hazard classification — Irritant and Corrosive pictograms
• PPE requirements — including safety goggles, PVC or neoprene gloves, coveralls and RPE for dry powder handling
• Emergency procedures — dry spill: vacuum or wet methods; wet spill: contain and absorb

Who Is This COSHH Assessment For?

This assessment is suitable for any workplace where tile grout is used, including:

• Tiling contractors in residential and commercial fit-out
• Swimming pool and wet room tiling specialists
• Construction and refurbishment contractors
• Building maintenance and facilities management teams

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.