DNRME Take 5 Water Monitoring v 2018.03.22

DNRME Take 5 - Generic v 2018.03.22

• Take 5 No.

• Name

• Date

  Date

• Work Description

• Location

• Address
  Address

• Risk Evaluation Table

  

For the following questions, document hazards, controls and risk levels in the applicable Add Notes section and take photos as required. (may need to click on the "paper clip" icon) Once the Take 5 is complete: * If in mobile reception, email to yourself and/or manager * If out of mobile reception, save the audit and email on return to the office.

Is the task/work a change from a current process, procedure or design?

• If Yes, you need to contact you supervisor/manager to obtain approval.<br>Once approval is obtained, undertake all required documentation before proceeding.

  Yes

  No

  NA

01. Do I have the required permits to do this work?

• If No do not proceed with the work until the required permits are in place.

  Yes

  No

  N/A

02. Can I be injured by being in, on or between anything?

• Pinch points, rotating machinery, conveyors, vehicles, beams, etc.

  Safe

  At Risk

  N/A

• Have the hazard/s been managed?

  Yes

  No

  N/A

03. Can I slip or trip on anything?

• Steep, slippery or uneven surfaces, poor housekeeping, tools, cables, debris, etc.

  Safe

  At Risk

  N/A

• Have the hazard/s been managed?

  Yes

  No

  N/A

04. Can I fall onto, into or from something?

• Work above 1.8 m, fall onto objects, from machinery, water, etc

  Safe

  At Risk

  N/A

• Have the hazard/s been managed?

  Yes

  No

  N/A

05. Can something fall on me and/or can I cause something to fall onto someone else?

• Falling tools, equipment, people working above or below me, vegetation, debris, etc.

  Safe

  At Risk

  N/A

• Have the hazard/s been managed?

  Yes

  No

  N/A

06. Can I be struck by any moving objects?

• Vehicles, machinery, boat, projectiles, debris, etc.

  Safe

  At Risk

  N/A

• Have the hazard/s been managed?

  Yes

  No

  N/A

07. Can I strain or over exert myself?

• Repetitive movements, pushing, pulling lifting, awkward posture, sustained posture, etc.

  Safe

  At Risk

  N/A

• Have the hazard/s been managed?

  Yes

  No

  N/A

08. Can I come into contact with or be exposed to something harmful?

• Heat, gases, electricity, oil, grease, acid, pneumatic, hydraulic, etc.

  Safe

  At Risk

  N/A

• Have the hazard/s been managed?

  Yes

  No

  N/A

09. Can I be injured by nearby activities or can my activities injure others?

• People working above or below me, dust, fumes, noise, sparks, projectiles, boats, cables, etc.

  Safe

  At Risk

  N/A

• Have the hazard/s been managed?

  Yes

  No

  N/A

10. Can I spill or pollute something?

• Spill or release oil, fuel, chemical, poison, etc. onto me or into waterways

  Safe

  At Risk

  N/A

• Have the hazard/s been managed?

  Yes

  No

  N/A

11. Does anything need to be isolated and tested for dead?

• Electricity, water, pneumatic, hydraulics, etc.

  Safe

  At Risk

  N/A

• Have the hazard/s been managed?

  Yes

  No

  N/A

12. Could there be uncontrolled movement?

• Ground failure, wall failure, roof failure, run away vehicle, flowing water, etc.

  Safe

  At Risk

  N/A

• Have the hazard/s been managed?

  Yes

  No

  N/A

13. Can weather conditions, work environment, fatigue, speed or poor lighting affect job safety?

• Temperature (cold/hot), humidity (low/high), storm, inadequate lighting, unrealistic schedule, rushing, lack of rest or sleep, etc.

  Safe

  At Risk

  N/A

• Have the hazard/s been managed?

  Yes

  No

  N/A

Do I have the required PPE?

• Eyes, ears, face, head, hands, feet, body, etc

  Yes

  No

  N/A

15. Are there any other hazards present that weren't accounted for?

• If "At Risk" then document the hazards, controls and risks. Include photos if required

  Safe

  At Risk

  N/A

• Have the hazard/s been managed?<br>(Document the risk rating and what controls were used or why no controls were required.)

  Yes

  No

  N/A

Signature

• Sign here

  Sign