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COSHH assessment form. A printable COSHH assessment for a cleaning task — the product, the hazards from its safety data sheet, who is exposed and how, and the controls that actually apply.

This is the paper version. CleanOptix does the same job on a phone, with the record filed against the site and the cleaner automatically.

First page of the COSHH assessment form PDF
2 pages · A4 · PDF

What is on the sheet

  • The task, the product used, and the area and surfaces it is used on
  • Hazards taken from the manufacturer's safety data sheet, referenced by its date and version
  • Who is exposed, how, and for how long in a shift
  • Controls in the order the Regulations expect them — substitute, control, then protect
  • Dilution, contact time and application method, taken from the product label rather than printed here
  • PPE required, storage, spillage, first aid and a review block tied to the data sheet version

Why this record matters

COSHH assessment is the duty most often discharged by filing a folder of safety data sheets. A data sheet is the manufacturer's information about a product; an assessment is what that means for your people doing your task in your building, and the two are not the same document.

So the form is built around the task rather than the product. The same bleach is a different assessment in a ventilated kitchen and a windowless toilet block, and an assessment per product cannot say so.

Dilution and contact time are fields copied from the label, never printed. They are product-specific and they change between a manufacturer's formulations, and a ratio on a free form is somebody mixing to the wrong strength for years — which here means an ineffective clean or a chemical burn.

The sheet says explicitly that products must not be mixed, and that is not boilerplate. The two things that produce chlorine gas are under every sink in the country, and the people most at risk are working alone, at night, in a small room, trying to shift something stubborn.

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© 2026 CleanOptix. Free to print, copy and use in your business. Not for resale. Please keep this notice.

Contains public sector information licensed under the Open Government Licence v3.0. General guidance, not legal advice. Checked October 2026.