Title Page
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Conducted on
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Job / Task
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SCR Number where Task is to be completed
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Client Site where Task is to be completed
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Technician
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UTC CARDINAL RULES I understand the UTC Cardinal Rules and understand that they are in place to protect my safety and that of my colleagues. I also understand that a breach of a Cardinal Rule may be considered serious misconduct, the penalty for which may lead up to and include dismissal, potentially ending my employment with Chubb New Zealand Ltd.
Take 5
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Am I fit to preform the task (aware, rested and alert)?
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Have I walked through and assessed the the area before commencing the task
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Am I using the correct tools / PPE for the task?
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Have I put all SAFE Controls in Place to ensure that I dont breach a Cardinal Rule
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Do I know what to do in an emergency
Assess for Potential Hazzards
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HAZARDOUS ENERGY ELECTRICAL - Do I need to isolate and test for Zero Energy State using LOTO and Volt Alert? ***For Security Systems under 50v DC ZES is not required***
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HAZARDOUS ENERGY MECHANICAL - Can I be harmed by stored energy (water, gas under pressure) heat, fumes, chemicals?
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FALL PROTECTION - Can I fall from height?
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WORKING UNDER SUSPENDED LOADS - Am I concerned that something may fall on me or strike me?
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Could there be uncontrolled movement?
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GRAVITY - Can I slip or trip on anything?
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MANUAL HANDLING - Can I strain or over exert myself?
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LINE OF FIRE - Can I be caught in, on, or between anything?
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Can I damage any equipment?
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Do I need to communicate to my workmates the risks associated with this task?
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ENVIRONMENT - Is there a chance I could spill or pollute something?
