Title Page
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Project Number / Name or Site
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Conducted on
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Prepared by / Personnel undertaking the task
- Shannon Gore
- Kizito Zulu
- Hope Chimutasha
- Steve Siladi
- Corey Polkinghorne
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Location
Take 5
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1. Are you mentally and physically fit to perform the task?
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If No, cease continuing Take 5 and contact your Supervisor
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2. Are you authorised to undertake this task?
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If No, cease continuing Take 5 and contact your Supervisor
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3. Do you have the correct PPE for the task and is it in good working order?
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If No, cease continuing Take 5 and contact your Supervisor or go and source correct PPE before proceeding
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Do you require any specific training
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Speak to your supervisor about Training
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Do your require a Permit
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Speak to your Supervisor about issuing a paper permit
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Do you have appropriate emergency equipment for the task / location you are working in and are you aware of the following:
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Contact your Supervisor and make yourself aware of the location of Emergency Equipment, Contact and Muster Point
Task Assessment
- Activity
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Against each task list the hazards that could result in injury/damage when the task is performed by the worker
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Select Activity
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Select Changing tracks, cutting edges or teeth Hazards
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Bites and Stings Controls
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Crush Injury Controls
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Cuts and Lacerations Controls
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Equipment failure Controls
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Exposure to Dusts, Chemicals or Fumes Controls
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Eye Injury and/or Hearing Damage Controls
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Falling Objects Controls
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Heat Stress Controls
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Inadequate Lighting Controls
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Injuries from using faulty hand tools Controls
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Isolated / Remote Work Controls
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Manual Handling Controls
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Plant on Plant / Person Controls
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Public / Unauthorised Entry Controls
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Slip, Trip, Fall Controls
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Stored Energy Controls
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Service / Structure Strike Controls
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Weather Controls
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Select General service, grease and oil change Hazards
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Select Bites and Stings Controls
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Burns Controls
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Confined Space Controls
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Crush Injury Controls
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Cuts and Lacerations Controls
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Damaged Lead or Burst Hose Controls
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Electrocution Controls
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Equipment failure Controls
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Exposure to Dusts, Chemicals or Fumes Controls
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Eye Injury and/or Hearing Damage Controls
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Falling Objects Controls
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Fire / Explosion Controls
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Heat Stress Controls
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Inadequate Lighting Controls
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Injuries from faulty compressor, hoses or tools Controls
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Injuries from using faulty hand tools Controls
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Isolated / Remote Work Controls
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Manual Handling Controls
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Plant on Plant / Person Controls
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Pressurised Air / Fluid Controls
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Public / Unauthorised Entry Controls
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Contact with Hazardous Chemicals Controls
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Slip, Trip, Fall Controls
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Oil / Chemical Spill Controls
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Stored Energy Controls
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Service / Structure Strike Controls
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Site Communication Controls
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Weather Controls
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Select Grinding and Cutting Hazards
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Bites and Stings Controls
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Burns Controls
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Confined Space Controls
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Crush Injury Controls
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Cuts and Lacerations Controls
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Damaged Lead or Burst Hose Controls
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Electrocution Controls
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Equipment failure Controls
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Exposure to Dusts, Chemicals or Fumes Controls
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Eye Injury and/or Hearing Damage Controls
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Falling Objects Controls
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Fire / Explosion Controls
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Heat Stress Controls
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Inadequate Lighting Controls
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Injuries from faulty compressor, hoses or tools Controls
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Injuries from using faulty hand tools Controls
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Grinder Kickback Controls
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Isolated / Remote Work Controls
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Manual Handling Controls
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Plant on Plant / Person Controls
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Public / Unauthorised Entry Controls
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Contact with Hazardous Chemicals Controls
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Slip, Trip, Fall Controls
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Oil / Chemical Spill Controls
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Stored Energy Controls
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Service / Structure Strike Controls
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Site Communication Controls
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Weather Controls
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Select Hydraulic hose / cyclinder repair Hazards
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Burns Controls
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Cuts and Lacerations Controls
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Damaged Lead or Burst Hose Controls
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Equipment failure Controls
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Exposure to Dusts, Chemicals or Fumes Controls
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Eye Injury and/or Hearing Damage Controls
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Falling Objects Controls
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Injuries from using faulty hand tools Controls
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Isolated / Remote Work Controls
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Manual Handling Controls
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Pressurised Air / Fluid Controls
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Contact with Hazardous Chemicals Controls
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Slip, Trip, Fall Controls
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Oil / Chemical Spill Controls
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Stored Energy Controls
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Select jacking and propping of mobile plant Hazards
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Crush Injury Controls
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Cuts and Lacerations Controls
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Equipment failure Controls
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Falling Objects Controls
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Heat Stress Controls
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Inadequate Lighting Controls
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Injuries from using faulty hand tools Controls
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Isolated / Remote Work Controls
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Manual Handling Controls
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Public / Unauthorised Entry Controls
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Slip, Trip, Fall Controls
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Stored Energy Controls
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Service / Structure Strike Controls
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Weather Controls
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Select Plant washdown - cleaning and degreasing parts Hazards
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Bites and Stings Controls
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Burns Controls
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Crush Injury Controls
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Cuts and Lacerations Controls
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Damaged Lead or Burst Hose Controls
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Electrocution Controls
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Equipment failure Controls
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Eye Injury and/or Hearing Damage Controls
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Falling Objects Controls
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Heat Stress Controls
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Inadequate Lighting Controls
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Injuries from faulty compressor, hoses or tools Controls
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Isolated / Remote Work Controls
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Manual Handling Controls
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Pressurised Air / Fluid Controls
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Public / Unauthorised Entry Controls
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Slip, Trip, Fall Controls
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Oil / Chemical Spill Controls
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Select Test and commission plant Hazards
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Bites and Stings Controls
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Burns Controls
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Confined Space Controls
- Yes
- No
- N/A
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Crush Injury Controls
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Cuts and Lacerations Controls
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Equipment failure Controls
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Eye Injury and/or Hearing Damage Controls
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Falling Objects Controls
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Isolated / Remote Work Controls
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Manual Handling Controls
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Plant on Plant / Person Controls
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Pressurised Air / Fluid Controls
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Public / Unauthorised Entry Controls
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Slip, Trip, Fall Controls
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Oil / Chemical Spill Controls
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Stored Energy Controls
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Service / Structure Strike Controls
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Site Communication Controls
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Weather Controls
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Select Tyre changing, inflation (compressed air) Hazards
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Bites and Stings Controls
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Burns Controls
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Crush Injury Controls
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Cuts and Lacerations Controls
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Damaged Lead or Burst Hose Controls
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Equipment failure Controls
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Eye Injury and/or Hearing Damage Controls
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Falling Objects Controls
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Heat Stress Controls
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Inadequate Lighting Controls
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Injuries from faulty compressor, hoses or tools Controls
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Injuries from using faulty hand tools Controls
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Isolated / Remote Work Controls
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Manual Handling Controls
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Pressurised Air / Fluid Controls
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Public / Unauthorised Entry Controls
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Slip, Trip, Fall Controls
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Stored Energy Controls
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Select Use of crane, forklift or load handling equipment Hazards
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Equipment failure Controls
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Falling Objects Controls
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Inadequate Lighting Controls
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Isolated / Remote Work Controls
- Yes
- No
- N/A
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Manual Handling Controls
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Plant on Plant / Person Controls
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Public / Unauthorised Entry Controls
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Slip, Trip, Fall Controls
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Stored Energy Controls
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Service / Structure Strike Controls
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Weather Controls
- Yes
- No
- N/A
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Select Welding and Oxy cutting Hazards
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Burns Controls
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Confined Space Controls
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Crush Injury Controls
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Cuts and Lacerations Controls
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Damaged Lead or Burst Hose Controls
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Electrocution Controls
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Equipment failure Controls
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Exposure to Dusts, Chemicals or Fumes Controls
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Eye Injury and/or Hearing Damage Controls
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Falling Objects Controls
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Fire / Explosion Controls
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Heat Stress Controls
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Inadequate Lighting Controls
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Grinder Kickback Controls
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Manual Handling Controls
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Slip, Trip, Fall Controls
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Any Additional Controls?
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Photo (optional)
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Risk Likelihood (chance of it happening)
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Select Consequence
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Intolerable - activity must not commence, immediate action required to eliminate or implement additional controls to reduce it to acceptable level (ALARP).
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Activity or task must not commence without approval of Operations Manager or CEO.
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Intolerable – must not commence without Construction Manager or higher approval and appropriate supervision present, implement additional controls reduce to ALARP.
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May be tolerable – will require attention and the implementation of additional controls to reduce to ALARP.
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Site management must determine appropriate level of management and supervision prior to commencement of activity.
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Consequence
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Intolerable - activity must not commence, immediate action required to eliminate or implement additional controls to reduce it to acceptable level (ALARP).
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Activity or task must not commence without approval of Operations Manager or CEO.
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Intolerable – must not commence without Construction Manager or higher approval and appropriate supervision present, implement additional controls reduce to ALARP.
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May be tolerable – will require attention and the implementation of additional controls to reduce to ALARP.
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Site management must determine appropriate level of management and supervision prior to commencement of activity.
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Consequence
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Intolerable – must not commence without Construction Manager or higher approval and appropriate supervision present, implement additional controls reduce to ALARP.
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May be tolerable – will require attention and the implementation of additional controls to reduce to ALARP.
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Site management must determine appropriate level of management and supervision prior to commencement of activity.
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Tolerable rating – monitor, manage and carry out activity in accordance with identified controls / routine procedures.0-
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Consequence
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Intolerable – must not commence without Construction Manager or higher approval and appropriate supervision present, implement additional controls reduce to ALARP.
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May be tolerable – will require attention and the implementation of additional controls to reduce to ALARP.
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Site management must determine appropriate level of management and supervision prior to commencement of activity.
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Tolerable rating – monitor, manage and carry out activity in accordance with identified controls / routine procedures.
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Consequence
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May be tolerable – will require attention and the implementation of additional controls to reduce to ALARP.
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Site management must determine appropriate level of management and supervision prior to commencement of activity.
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Tolerable rating – monitor, manage and carry out activity in accordance with identified controls / routine procedures.
Team Members
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Select Name
- Shannon Gore
- Kizito Zulu
- Hope Chimutasha
- Steve Siladi
- Corey Polkinghorne
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Shannon Gore
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Kizito Zulu
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Hope Chimutasha
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Steve Siladi
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Corey Polkinghorne
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Is Supervisor available to review and sign off?
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Supervisors Name and Signature
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Supervisors Number
Approval
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Date and time of approval
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Approver's signature
