Information

  • Document No.

  • Client / Site

  • AREA:

  • Conducted on

  • TASK:

  • Entered by:

  • Location
  • UTAKE 5 completed by:

  • UTAKE 5 completed when:

Step 1. STOP AND LOOK

Step 2. THINK THROUGH THE TASK

  • Work scope / Procedures / JHA or JSA understood and in use

  • Correct permit requirements obtained and in use

  • Correct PPE obtained and in use

  • Correct Tools / Equipment used and in good order

Step 3. IDENTIFY THE HAZARDS

  • Look close

  • Look wide

  • Look for the hidden

  • Hazard Details - List or take a picture(s) of the hazards you identified - Hazards identified are:

  • Add media

Step 4. CONTROL AND COMMUNICATION

  • Hazard Control Details - List or take a picture of how the hazard(s) will be controlled to protect you:

  • Add media

  • Hazards controlled before the task is started

  • Share learnings with others in crew / team - Do the people working with you understand the hazards and controls in the same way you do?

Step 5. DO THE TASK SAFELY

  • Control - Hazards must be controlled before the task is started - Can the job be done safely? (If no, STOP and contact your Supervisor)

  • AFTER A BREAK - STOP, LOOK, AND REVIEW YOUR UTAKE 5
    Complete and send this document to your Supervisor

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