Carna_Take 5

• Client / Site

• Prepared by

• Conducted on

  Date

TAKE 5

• Task To Be Completed

• Emergency Radio Channel

CHECKLIST

• Am I authorised to perform the job? (Trained and deemed component)

  Yes

  No

  N/A

• Am I physically able to do the task?

  Yes

  No

  N/A

• Have I read/signed off on any procedures, work instruction or JHA for the job?

  Yes

  No

  N/A

• Do I have the correct tools or equipment for the job?

  Yes

  No

  N/A

• Has a pre-start been conducted for equipment or machinery I will be using?

  Yes

  No

  N/A

• Have energy sources been identified, isolated, locked out and tagged? (Test and try)

  Yes

  No

  N/A

• Have I inspected my work area? Do I know what is going on around my job?

  Yes

  No

  N/A

• Are driving conditions safe?

  Yes

  No

  N/A

• Do I have the correct PPE for the job? Is it in good condition?

  Yes

  No

  N/A

• Have I checked that controls are in place? Are they working and effective?

  Yes

  No

  N/A

HAZARD CONTROL

• 

• Am I working around other people who could be affected by my task?

  Yes

  No

  N/A

• List Controls

• Residual Risk (refer to risk matrix)

  Extreme

  High

  Moderate

  Low

• Have environmental conditions changed? Have they created new hazards?

  Yes

  No

  N/A

• List Controls

• Residual Risk (refer to risk matrix)

  Extreme

  High

  Moderate

  Low

• Is there the chance that I could spill/pollute/damage/disturb the environment/community?

  Yes

  No

  N/A

• List Controls

• Residual Risk (refer to risk matrix)

  Extreme

  High

  Moderate

  Low

• Will I be working with hazardous materials? (refer to MSDS)

  Yes

  No

  N/A

• List Controls

• Residual Risk (refer to risk matrix)

  Extreme

  High

  Moderate

  Low

• Could I be struck by something or caught in, on, or between?

  Yes

  No

  N/A

• List Controls

• Residual Risk (refer to risk matrix)

  Extreme

  High

  Moderate

  Low

• Is it possible to slip, trip or fall more than 1.8mtrs?

  Yes

  No

  N/A

• List Controls

• Residual Risk (refer to risk matrix)

  Extreme

  High

  Moderate

  Low

• Are there any other hazards present?

Hazard

• Hazard

• List Controls

• Residual Risk (refer to risk matrix)

  Extreme

  High

  Moderate

  Low

PERMITS

• NOTE: IF ANY PERMITS ARE REQUIRED, CONTACT YOUR SUPERVISOR BEFORE COMMENCING YOUR TASK.

• Confined Space

  Yes

  No

• Hot Works

  Yes

  No

• Working at Heights

  Yes

  No

• Excavation/Dig Permit

  Yes

  No

• Vicinity/High Voltage Permit

  Yes

  No

• Environmental/Cultural Permit

  Yes

  No

• Other, please specify

• Employee Signature

  Sign

Take 5's to be passed onto Safety Department at the end of each shift.