Information
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Take 5 No.
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Name
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Date
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Location
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Address
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Task
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Risk Evaluation Matrix
Hazard Checklist
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01. Do I understand the task/work?
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02. Am I trained, competent and authorised to do this task?
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03. Are tools/equipment fit for purpose and task/work?
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04. Can I be injured by nearby activities or can my activities injure others nearby?
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05. Can I strain or over exert myself?
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06. Can I slip or trip on anything?
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07. Can I fall onto, into or from anything?
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08. Can something fall on me or can I cause something to fall onto someone else?
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09. Can I come into contact with or be exposed to something that may harm me?
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10. Does anything need to be isolated and tested for dead? (e.g. electrical, hydraulics, gas)
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11. Can I spill or pollute something?
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12. Can weather conditions or work environment affect job safety? (e.g. poor lighting, tidal zones, excessive heat or cold, storms, etc.)
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13. Will communications reception be limited while doing the task?
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14. Is there a safer way I can do the task?
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15. Do I need to report into Field Ops (eg. 3 Messaging) while this task is being done?
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16. Are there any other hazards that need to be accounted for?
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17. Have I got the required PPE/provisions?
