Cubic TAKE 5 Checklist

THINK About The Task

• Do you understand the task?

  Yes

  No

• DO NOT PROCEED! CONTACT MANAGER

• Do you understand the Procedure?

  Yes

  No

• DO NOT PROCEED! CONTACT MANAGER

• Do you have the correct tools?

  Yes

  No

• Are they in good condition?

  Yes

• DO NOT PROCEED! CONTACT MANAGER

• DO NOT PROCEED! CONTACT MANAGER

• Do you have the correct PPE?

  Yes

  No

• DO NOT PROCEED! CONTACT MANAGER

IDENTIFY The Hazards

• Manual Handling, Slips, Trips, Falls?

  Safe

  At Risk

• What is the Risk?

• Draw Here

  Drawing

• Take Photos

  Media

• COMPLETE 'ASSESS THE RISK' SECTION

• Mechanical, Moving Parts, Etc?

  Safe

  At Risk

• What is the Risk?

• Draw Here

  Drawing

• Take Photos

  Media

• COMPLETE 'ASSESS THE RISK' SECTION

• Are there any Energy Sources?

  Yes

  N/A

• Electricity

  Safe

  At Risk

  N/A

• What is the Risk?

• Draw Here

  Drawing

• Take Photos

  Media

• COMPLETE 'ASSESS THE RISK' SECTION

• Water

  Safe

  At Risk

  N/A

• What is the Risk?

• Draw Here

  Drawing

• Take Photos

  Media

• COMPLETE 'ASSESS THE RISK' SECTION

• Hydraulic

  Safe

  At Risk

  N/A

• What is the Risk?

• Draw Here

  Drawing

• Take Photos

  Media

• COMPLETE 'ASSESS THE RISK' SECTION

• Gas

  Safe

  At Risk

  N/A

• What is the Risk?

• Draw Here

  Drawing

• Take Photos

  Media

• COMPLETE 'ASSESS THE RISK' SECTION

• Chemical

  Safe

  At Risk

  N/A

• What is the Risk?

• Draw Here

  Drawing

• Take Photos

  Media

• COMPLETE 'ASSESS THE RISK' SECTION

• Steam

  Safe

  At Risk

  N/A

• What is the Risk?

• Draw Here

  Drawing

• Take Photos

  Media

• COMPLETE 'ASSESS THE RISK' SECTION

• Surroundings (Overhead, Noise, Heat, Cold)?

  Safe

  At Risk

• What is the Risk?

• Draw Here

  Drawing

• Take Photos

  Media

• COMPLETE 'ASSESS THE RISK' SECTION

• Chemicals, Biological, Radiation?

  Safe

  At Risk

• What is the Risk?

• Draw Here

  Drawing

• Take Photos

  Media

• COMPLETE 'ASSESS THE RISK' SECTION

• Any other Hazards?

  Safe

  At Risk

• What is the Risk?

• Draw Here

  Drawing

• Take Photos

  Media

• COMPLETE 'ASSESS THE RISK' SECTION

ASSESS The Risk

• Risk Matrix

  

• What is the Risk Result?

  LOW

  MEDIUM

  HIGH

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

• Review Controls and ensure they are accurate.

• Have you Assessed ALL 'At Risk' Items

  Yes

  No

• DO NOT PROCEED! ASSESS ALL ITEMS!

• COMMENTS

MANAGE The Changes

• Hazards eliminated or controlled?

  Yes

  N/A

• Issues discussed with Manager

  Yes

  N/A

PROCEED With The Task

• Sign Here

  Sign

• Please Sign before continuing.