Information

  • Site and Date

  • Prepared by

  • Risk Assessment Completed

  • TAKE 5

  • Do I Fully Understand This Task?

  • Controls

  • Am I Fit To Carry Out The Task?

  • Controls

  • Do I Have The Correct Tools for the Task?

  • Controls

  • Is there a procedure or JSEA for the Task and have you read and Understood it?

  • Controls

  • Am I trained and competent to carry out the task?

  • Controls

  • Do I have the correct PPE for the Task?

  • Controls

  • Is my work area safe?

  • Controls

  • Can I get caught in or between anything?

  • Controls

  • Can My work affect anybody else's safety eg Interaction ?

  • Controls

  • Have I identified and Isolated any dangerous energy sources?

  • Controls

  • Is there exposure to excessive Heat/Dust/Noise/Vibration?

  • Controls

  • Can anything fall on me?

  • Controls

  • Is a Permit required?

  • Controls

  • Can my actions harm the environment?

  • Controls

  • Other

  • Controls

  • List

  • Are All Hazards Assessed and Controls in place

  • DO NOT PROCEED CONTACT YOUR SUPERVISOR

  • Sign

  • Person
  • Add signature

OVERHEAD BINS

  • Gates Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Solenoids Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Rams and Clevises Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Airlines Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

GROUND BINS

  • Vibrators Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Gates and Adjusters Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Rams and Clevises Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Airlines Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Solenoids Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

AGG BINS

  • Vibrators Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Gates and Adjusters Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Rams and Clevises Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Airlines Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Hanging Bolts Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

CEMENT BIN

  • Vibrators Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Discharge Valves Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Rams and Clevises Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Aeration Equipment Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

BATCH CONVEYOR

  • Scrapers Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Gearbox Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Bearings Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • V-Belts Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Pulleys Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Conveyor Belt Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Skirting Rubbers Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Rollers Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Gob Hopper Sock Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

COMPRESSOR

  • Filters Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Oilers Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Airlines Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

WATER TANKS

  • Socks Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Build up Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Discharge Valves Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

SILOS

  • Overfill Valves Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Vibrators Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Pressure Relief Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Discharge Valves Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Solenoids Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Air Slides Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Aeration Equipment Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Cam locks and Caps Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Socks Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

GENERAL

  • All Guarding Checked

  • Any Issues Found

  • Photographs

  • Issue Found

  • Immediate Corrective Actions Required

  • Immediate Corrective Actions

  • Person Responsible

  • Time inspected

  • Is the General Area Clean

  • Reason

  • Add media

  • Generator Hours

  • Generator
  • Hours

  • Comments

  • Any Further Issues

  • Suggestions

  • Add media

  • Down Time
  • Start of down time

  • Down Time

  • Reason

  • Total Down Time

  • Total Cubic Metres

  • TASKS REQUIRED

  • Check Complete

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.