BRISBANE - Take 3 Safety Checklist

• Conducted on

  Date

TAKE 3 SAFETY CHECKLIST

General Information

• Conducted on

  Date

• Name/s

• Task

Think Through the Task

• Work Scope Undestood?

  Yes

  No

  N/A

• SWI / JSA Available?

  Yes

  No

  N/A

• Work Permits Obtained?

  Yes

  No

  N/A

• Correct PPE?

  Yes

  No

  N/A

• Equipment In Good Order?

  Yes

  No

  N/A

Hazards Report and Contol

Hazards

• Spot the Hazard

• High Risk

• Medium Risk

• Low Risk

• Insert Photo of Hazard (optional)

  Media

• Hazard Control Measures