AMO TAKE 5

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?

What is the Risk?

Draw Here
Take Photos

COMPLETE 'ASSESS THE RISK' SECTION

Mechanical, Moving Parts, Etc?

What is the Risk?

Draw Here
Take Photos

COMPLETE 'ASSESS THE RISK' SECTION

Are there any Energy Sources?

Electricity

What is the Risk?

Draw Here
Take Photos

COMPLETE 'ASSESS THE RISK' SECTION

Water

What is the Risk?

Draw Here
Take Photos

COMPLETE 'ASSESS THE RISK' SECTION

Hydraulic

What is the Risk?

Draw Here
Take Photos

COMPLETE 'ASSESS THE RISK' SECTION

Gas

What is the Risk?

Draw Here
Take Photos

COMPLETE 'ASSESS THE RISK' SECTION

Chemical

What is the Risk?

Draw Here
Take Photos

COMPLETE 'ASSESS THE RISK' SECTION

Steam

What is the Risk?

Draw Here
Take Photos

COMPLETE 'ASSESS THE RISK' SECTION

Surroundings (Overhead, Noise, Heat, Cold)?

What is the Risk?

Draw Here
Take Photos

COMPLETE 'ASSESS THE RISK' SECTION

Chemicals, Biological, Radiation?

What is the Risk?

Draw Here
Take Photos

COMPLETE 'ASSESS THE RISK' SECTION

Any other Hazards?

What is the Risk?

Draw Here
Take Photos

COMPLETE 'ASSESS THE RISK' SECTION

ASSESS The Risk

Risk Matrix

Risk Matrix

What is the Risk Result?

DO NOT PROCEED, COMPLETE A FULL JOB SAFETY ANALYSIS (JSA)

Review Controls and ensure they are accurate.

Have you Assessed ALL 'At Risk' Items

DO NOT PROCEED! ASSESS ALL ITEMS!

COMMENTS

MANAGE The Changes

Hazards eliminated or controlled?

Issues discussed with Manager

PROCEED With The Task
Sign Here

Please Sign before continuing.

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.