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Report and assessor identification

Operator name COIN Company Assessor

Establishmentaddress

COIN Site Team/unit

Date of report COIN Service Order Discipline

ASSESSMENT RECORD

DESCRIPTIVE ASPECTS

Please note - all rows are expandable

Descriptive CriterionSaet! Report

ResCo""ents

#$%The safety report should ive details to allo! communication !iththe competent authority"

Dan&ero's S'bstances

#$(The safety report should identify the ma#imum $uantities of everydanerous substance present% or potentially present% on the

establishment"#$)&or each danerous substance identified% the safety report shoulddescribe its chemical name 'includin common use chemical name( andCAS number% accordin to I)*AC nomenclature"

#$*The safety report should describe the physical and chemicalbehaviour of each danerous substance identified% relevant to normaloperatin conditions and foreseeable accident conditions"

#$+The safety report should describe the immediate and delayed harmto man and the environment for each danerous substance identified"

Environ"ent

#$,The safety report should describe the environment of the

establishment in sufficient detail to allo! the conse$uences ma+oraccidents to be assessed"

#$The safety report should describe the environment of theestablishment in sufficient detail to allo! the contribution of e#ternalfactors to ma+or accidents at the establishment to be assessed"

,ersion -". April 00.

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