Title Page

  • Project Number / Name or Site

  • Conducted on

  • Prepared by / Personnel undertaking the task

  • Location

Take 5

  • 1. Are you mentally and physically fit to perform the task?

  • If No, cease continuing Take 5 and contact your Supervisor

  • 2. Are you authorised to undertake this task?

  • If No, cease continuing Take 5 and contact your Supervisor

  • 3. Do you have the correct PPE for the task and is it in good working order?

  • If No, cease continuing Take 5 and contact your Supervisor or go and source correct PPE before proceeding

  • Do you require any specific training

  • Speak to your supervisor about Training

  • Do your require a Permit

  • Speak to your Supervisor about issuing a paper permit

  • Do you have appropriate emergency equipment for the task / location you are working in and are you aware of the following:

  • Contact your Supervisor and make yourself aware of the location of Emergency Equipment, Contact and Muster Point

Task Assessment

    Activity
  • Against each task list the hazards that could result in injury/damage when the task is performed by the worker

  • Select Activity

  • Select Changing tracks, cutting edges or teeth Hazards

  • Bites and Stings Controls

  • Crush Injury Controls

  • Cuts and Lacerations Controls

  • Equipment failure Controls

  • Exposure to Dusts, Chemicals or Fumes Controls

  • Eye Injury and/or Hearing Damage Controls

  • Falling Objects Controls

  • Heat Stress Controls

  • Inadequate Lighting Controls

  • Injuries from using faulty hand tools Controls

  • Isolated / Remote Work Controls

  • Manual Handling Controls

  • Plant on Plant / Person Controls

  • Public / Unauthorised Entry Controls

  • Slip, Trip, Fall Controls

  • Stored Energy Controls

  • Service / Structure Strike Controls

  • Weather Controls

  • Select General service, grease and oil change Hazards

  • Select Bites and Stings Controls

  • Burns Controls

  • Confined Space Controls

  • Crush Injury Controls

  • Cuts and Lacerations Controls

  • Damaged Lead or Burst Hose Controls

  • Electrocution Controls

  • Equipment failure Controls

  • Exposure to Dusts, Chemicals or Fumes Controls

  • Eye Injury and/or Hearing Damage Controls

  • Falling Objects Controls

  • Fire / Explosion Controls

  • Heat Stress Controls

  • Inadequate Lighting Controls

  • Injuries from faulty compressor, hoses or tools Controls

  • Injuries from using faulty hand tools Controls

  • Isolated / Remote Work Controls

  • Manual Handling Controls

  • Plant on Plant / Person Controls

  • Pressurised Air / Fluid Controls

  • Public / Unauthorised Entry Controls

  • Contact with Hazardous Chemicals Controls

  • Slip, Trip, Fall Controls

  • Oil / Chemical Spill Controls

  • Stored Energy Controls

  • Service / Structure Strike Controls

  • Site Communication Controls

  • Weather Controls

  • Select Grinding and Cutting Hazards

  • Bites and Stings Controls

  • Burns Controls

  • Confined Space Controls

  • Crush Injury Controls

  • Cuts and Lacerations Controls

  • Damaged Lead or Burst Hose Controls

  • Electrocution Controls

  • Equipment failure Controls

  • Exposure to Dusts, Chemicals or Fumes Controls

  • Eye Injury and/or Hearing Damage Controls

  • Falling Objects Controls

  • Fire / Explosion Controls

  • Heat Stress Controls

  • Inadequate Lighting Controls

  • Injuries from faulty compressor, hoses or tools Controls

  • Injuries from using faulty hand tools Controls

  • Grinder Kickback Controls

  • Isolated / Remote Work Controls

  • Manual Handling Controls

  • Plant on Plant / Person Controls

  • Public / Unauthorised Entry Controls

  • Contact with Hazardous Chemicals Controls

  • Slip, Trip, Fall Controls

  • Oil / Chemical Spill Controls

  • Stored Energy Controls

  • Service / Structure Strike Controls

  • Site Communication Controls

  • Weather Controls

  • Select Hydraulic hose / cyclinder repair Hazards

  • Burns Controls

  • Cuts and Lacerations Controls

  • Damaged Lead or Burst Hose Controls

  • Equipment failure Controls

  • Exposure to Dusts, Chemicals or Fumes Controls

  • Eye Injury and/or Hearing Damage Controls

  • Falling Objects Controls

  • Injuries from using faulty hand tools Controls

  • Isolated / Remote Work Controls

  • Manual Handling Controls

  • Pressurised Air / Fluid Controls

  • Contact with Hazardous Chemicals Controls

  • Slip, Trip, Fall Controls

  • Oil / Chemical Spill Controls

  • Stored Energy Controls

  • Select jacking and propping of mobile plant Hazards

  • Crush Injury Controls

  • Cuts and Lacerations Controls

  • Equipment failure Controls

  • Falling Objects Controls

  • Heat Stress Controls

  • Inadequate Lighting Controls

  • Injuries from using faulty hand tools Controls

  • Isolated / Remote Work Controls

  • Manual Handling Controls

  • Public / Unauthorised Entry Controls

  • Slip, Trip, Fall Controls

  • Stored Energy Controls

  • Service / Structure Strike Controls

  • Weather Controls

  • Select Plant washdown - cleaning and degreasing parts Hazards

  • Bites and Stings Controls

  • Burns Controls

  • Crush Injury Controls

  • Cuts and Lacerations Controls

  • Damaged Lead or Burst Hose Controls

  • Electrocution Controls

  • Equipment failure Controls

  • Eye Injury and/or Hearing Damage Controls

  • Falling Objects Controls

  • Heat Stress Controls

  • Inadequate Lighting Controls

  • Injuries from faulty compressor, hoses or tools Controls

  • Isolated / Remote Work Controls

  • Manual Handling Controls

  • Pressurised Air / Fluid Controls

  • Public / Unauthorised Entry Controls

  • Slip, Trip, Fall Controls

  • Oil / Chemical Spill Controls

  • Select Test and commission plant Hazards

  • Bites and Stings Controls

  • Burns Controls

  • Confined Space Controls

  • Crush Injury Controls

  • Cuts and Lacerations Controls

  • Equipment failure Controls

  • Eye Injury and/or Hearing Damage Controls

  • Falling Objects Controls

  • Isolated / Remote Work Controls

  • Manual Handling Controls

  • Plant on Plant / Person Controls

  • Pressurised Air / Fluid Controls

  • Public / Unauthorised Entry Controls

  • Slip, Trip, Fall Controls

  • Oil / Chemical Spill Controls

  • Stored Energy Controls

  • Service / Structure Strike Controls

  • Site Communication Controls

  • Weather Controls

  • Select Tyre changing, inflation (compressed air) Hazards

  • Bites and Stings Controls

  • Burns Controls

  • Crush Injury Controls

  • Cuts and Lacerations Controls

  • Damaged Lead or Burst Hose Controls

  • Equipment failure Controls

  • Eye Injury and/or Hearing Damage Controls

  • Falling Objects Controls

  • Heat Stress Controls

  • Inadequate Lighting Controls

  • Injuries from faulty compressor, hoses or tools Controls

  • Injuries from using faulty hand tools Controls

  • Isolated / Remote Work Controls

  • Manual Handling Controls

  • Pressurised Air / Fluid Controls

  • Public / Unauthorised Entry Controls

  • Slip, Trip, Fall Controls

  • Stored Energy Controls

  • Select Use of crane, forklift or load handling equipment Hazards

  • Equipment failure Controls

  • Falling Objects Controls

  • Inadequate Lighting Controls

  • Isolated / Remote Work Controls

  • Manual Handling Controls

  • Plant on Plant / Person Controls

  • Public / Unauthorised Entry Controls

  • Slip, Trip, Fall Controls

  • Stored Energy Controls

  • Service / Structure Strike Controls

  • Weather Controls

  • Select Welding and Oxy cutting Hazards

  • Burns Controls

  • Confined Space Controls

  • Crush Injury Controls

  • Cuts and Lacerations Controls

  • Damaged Lead or Burst Hose Controls

  • Electrocution Controls

  • Equipment failure Controls

  • Exposure to Dusts, Chemicals or Fumes Controls

  • Eye Injury and/or Hearing Damage Controls

  • Falling Objects Controls

  • Fire / Explosion Controls

  • Heat Stress Controls

  • Inadequate Lighting Controls

  • Grinder Kickback Controls

  • Manual Handling Controls

  • Slip, Trip, Fall Controls

  • Any Additional Controls?

  • Photo (optional)

  • Risk Matrix.PNG
  • Risk Likelihood (chance of it happening)

  • Select Consequence

  • Intolerable - activity must not commence, immediate action required to eliminate or implement additional controls to reduce it to acceptable level (ALARP).

  • Activity or task must not commence without approval of Operations Manager or CEO.

  • Intolerable – must not commence without Construction Manager or higher approval and appropriate supervision present, implement additional controls reduce to ALARP.

  • May be tolerable – will require attention and the implementation of additional controls to reduce to ALARP.

  • Site management must determine appropriate level of management and supervision prior to commencement of activity.

  • Consequence

  • Intolerable - activity must not commence, immediate action required to eliminate or implement additional controls to reduce it to acceptable level (ALARP).

  • Activity or task must not commence without approval of Operations Manager or CEO.

  • Intolerable – must not commence without Construction Manager or higher approval and appropriate supervision present, implement additional controls reduce to ALARP.

  • May be tolerable – will require attention and the implementation of additional controls to reduce to ALARP.

  • Site management must determine appropriate level of management and supervision prior to commencement of activity.

  • Consequence

  • Intolerable – must not commence without Construction Manager or higher approval and appropriate supervision present, implement additional controls reduce to ALARP.

  • May be tolerable – will require attention and the implementation of additional controls to reduce to ALARP.

  • Site management must determine appropriate level of management and supervision prior to commencement of activity.

  • Tolerable rating – monitor, manage and carry out activity in accordance with identified controls / routine procedures.0-

  • Consequence

  • Intolerable – must not commence without Construction Manager or higher approval and appropriate supervision present, implement additional controls reduce to ALARP.

  • May be tolerable – will require attention and the implementation of additional controls to reduce to ALARP.

  • Site management must determine appropriate level of management and supervision prior to commencement of activity.

  • Tolerable rating – monitor, manage and carry out activity in accordance with identified controls / routine procedures.

  • Consequence

  • May be tolerable – will require attention and the implementation of additional controls to reduce to ALARP.

  • Site management must determine appropriate level of management and supervision prior to commencement of activity.

  • Tolerable rating – monitor, manage and carry out activity in accordance with identified controls / routine procedures.

Team Members

  • Select Name

  • Ben Williams Signature

  • Jack Ellul Signature

  • Ben Wan Signature

  • Ray Zerafa Signature

  • Is Supervisor available to review and sign off?

  • Supervisors Signature

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.