Carey Take Time Talk

• Conducted on

  Date

• Prepared by

• Location
  Address

• Date and time:

  Date
• Work area location:
  Address

• Please enter any positive observations below:

• Please enter details about any gaps or opportunities for improvement below. Please also enter details about immediate actions taken:

At-risk behaviour/conditions

• Were any at-risk behaviours/conditions observed?

  Yes

  No

  N/A

Category of at-risk behaviour/condition observed. Please indicate below if any are applicable

• Ears

  Off

  On

• Eyes and face

  Off

  On

• Head

  Off

  On

• Hands and arms

  Off

  On

• Feet and legs

  Off

  On

• Respiratory

  Off

  On

• Body

  Off

  On

• Striking against

  Off

  On

• Caught between

  Off

  On

• Struck by

  Off

  On

• Eyes on task

  Off

  On

• Eyes on path

  Off

  On

• Potential to fall

  Off

  On

• Poor housekeeping

  Off

  On

• Inadequate storage

  Off

  On

• Unclean work area

  Off

  On

• Poor lighting

  Off

  On

• Extreme weather

  Off

  On

• Dust/fume exposure

  Off

  On

• Not barricaded

  Off

  On

• Lifting & twisting

  Off

  On

• Over extension

  Off

  On

• Cramped

  Off

  On

• Poor posture

  Off

  On

• Inadequate risk assessment/procedures

  Off

  On

• Risk assessment/procedures not known or understood

  Off

  On

• Risk assessment/procedures not followed

  Off

  On

• Tools/equipment not right for the job

  Off

  On

• Tools/equipment used incorrectly

  Off

  On

• Unsafe condition

  Off

  On

• Was the activity stopped due to at-risk behaviours/conditions?

  Yes

  No

  N/A

• Was the TTT coached?

  Yes

  No

  N/A

• Who was the coach?

• Signature:

  Sign