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Free Cubic TAKE 5 Checklist
THINK About The Task
Do you understand the task?
DO NOT PROCEED! CONTACT MANAGER
Do you understand the Procedure?
DO NOT PROCEED! CONTACT MANAGER
Do you have the correct tools?
Are they in good condition?
DO NOT PROCEED! CONTACT MANAGER
DO NOT PROCEED! CONTACT MANAGER
Do you have the correct PPE?
DO NOT PROCEED! CONTACT MANAGER
IDENTIFY The Hazards
Manual Handling, Slips, Trips, Falls?
COMPLETE 'ASSESS THE RISK' SECTION
Mechanical, Moving Parts, Etc?
COMPLETE 'ASSESS THE RISK' SECTION
Are there any Energy Sources?
COMPLETE 'ASSESS THE RISK' SECTION
COMPLETE 'ASSESS THE RISK' SECTION
COMPLETE 'ASSESS THE RISK' SECTION
COMPLETE 'ASSESS THE RISK' SECTION
COMPLETE 'ASSESS THE RISK' SECTION
COMPLETE 'ASSESS THE RISK' SECTION
Surroundings (Overhead, Noise, Heat, Cold)?
COMPLETE 'ASSESS THE RISK' SECTION
Chemicals, Biological, Radiation?
COMPLETE 'ASSESS THE RISK' SECTION
COMPLETE 'ASSESS THE RISK' SECTION
ASSESS The Risk
DO NOT PROCEED, COMPLETE A FULL JOB SAFETY ANALYSIS (JSA)
Review Controls and ensure they are accurate.
Have you Assessed ALL 'At Risk' Items
MANAGE The Changes
Hazards eliminated or controlled?
Issues discussed with Manager
PROCEED With The Task
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to
take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment;
or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is
permissible in your workplace or jurisdiction.
