GVW STOP! Take 5 and think about your work activity (Form QF-GVW-53 Feb 2013)

Prepared by

Select date

Task description or Hansen reference number

You must have appropriate training, licenses and/or tickets for the task! Do not proceed without them

Each question must be answered

Is there a Standard Operating Instruction or Safe Work Instruction for the task?

If there is an SWI, have you completed competency against it (if required) or read and understood it?

Do not continue, discuss with your Supervisor

High Risk Works

Is Mechanical Excavation required?

Are there Overhead or Underground Services or Electrical cabling in the work area?

Is Asbestos Removal required?

Is Traffic Management required?

Are Hot Work Activities required?

Is Confined Space Entry required?

Will you be Working at Height?

Is boating required? If 'yes' please complete the Boating Risk Assessment QF-GVW-314 available on SharePoint

Is there a level of Environmental risk considered to be in excess of routine duties and/or training?

For 'Yes' answered High Risk Works a High Risk Works Site Risk Assessment and/or a JSEA must be completed

Additional Hazards/Issues (Detail controls in place)

Note any other hazards or issues

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.