Title Page

  • Site conducted

  • Conducted on

  • What was the unsafe act that has been stopped

  • Please summarise the unsafe act that has been stopped

  • Person stopping the unsafe act

STAR Assessment

STOP

  • Is there a risk assessment available for this task?

  • Please complete a suitable risk assessment

  • Please review the risk assessment

  • Who was involved in the unsafe act (use initials only)?

  • Why was the task stopped?

  • Provide information regarding the operation and why it was considered unsafe.

  • What unsafe behaviours were witnessed?

  • Why was the work area unsafe? Please provide details

  • Has the equipment been inspected prior to use?

  • What makes the equipment unsafe? Please provide details

  • What materials are being used that are unsafe?

THINK

  • How can this act be made safe?

  • What aspect of the operation should be improved?

  • How can the behavior be improved?

  • Please describe what other action is required to improve behaviour

  • How can the equipment be improved?

  • Please describe other improvement to the equipment

  • How can the work area be improved?

  • Describe what other improvement is required in the work area to make the act safe

  • Can another material be used instead?

  • What material can be used instead?

ACT

  • Have the improvements considered above been communicated to the individuals involved in the unsafe act?

  • Please sign to confirm that you have received the improvements communication

  • Can the task now be completed safely?

  • Continue to THINK how the task can be made safe - If it is not possible do not continue.

REVIEW

  • Was this task made safer from the improvements detailed above?

  • Can this improvement be a permanent corrective action for this type of task?

  • Please raise actions on how these actions can become permanent, for example , retraining, process improvements, risk assessment review etc

Sign off

  • Full name

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.