Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
Section 1 - STOP step back and look
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Do understand what need to do?
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Do have the correct PPE and is it in good condition for the task?
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Do have the suitable tools and equipment for the task?
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Am trained, competent, licensed and fit to perform the task?
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Are there any Hazards Above, Below, Behind or Inside?
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Does this task include any of the following? Working at Heights, Confined Space, High Voltage Electrical, Ground Penetration, Guard or Interlock Impairment, Insulated Sandwich Panel or Isolation? If YES a High Risk Work Permit may be required
Section 2 - THINK - Identify the hazards
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Does the task involve any of the following hazards?
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Chemical (e.g. handling, inhaling, touching substances)
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Dust and Fume (e.g. welding fume, asbestos dust/fiber)
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Electrical (e.g. S/B with energy rating > CAT-2 or no rating or live electrical conductors or live work)
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Environmental (e.g. spills, odors, air emissions)
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Gravity (e.g. Slips, trips and falls, or struck by falling objects)
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Manual Handling (e.g. lifting awkward positions, over-exertion,is additional help or assistance required to complete the task?)
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Mechanical (e.g. caught in moving parts, struck by plant or flying objects)
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Noise (e.g. hearing damage, masking of emergency alarms)
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Pressure (e.g. contact with pressurized fluid, gas, air)
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Traffic Management (e.g. no 10-meter segregation from moving mobile plant)
Section 3 - PLAN - Assess the level of risk
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Are the risks documented for Red Hazards?
Section 4 - ACT - Control the Hazards
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Are Hazards effectively controlled?
Section 5 - REVIEW - Proceed safely and review
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Is it safe to proceed?
