IAS_Take 5

• Supervisor

• Job Description (Enter the name of the specific task, eg. pulling tarps, not the overall task, eg. tarping)

• Site Location (Ask supervisor if unknown)

• Prepared By

• Conducted On

  Date

HAZARD IDENTIFICATION

Focus on Task - Personal Controls

• Do you have the correct PPE to complete this task?

  Yes

  No

  N/A

• Is all the equipment and machinery I will use for this task in good working condition and safe to use?

  Yes

  No

  N/A

• Is all the electrical and/or lifting equipment I am using for this task tagged and inspected?

  Yes

  No

  N/A

• Have you signed onto the correct JHA or any other safety or training documents required for this task?

  Yes

  No

  N/A

• If you answered No to any of the above questions please list them in the text box below and also report to your supervisor immediately.

Focus on Task - Critical Risks

• Are there overhead power lines within the 10 metres of my work area?

  Yes

  No

  Not Applicable

• Will adverse weather conditions have an impact on the task I am completing?

  Yes

  No

  Not Applicable

• Am I working in and around mobile plant?

  Yes

  No

  Not Applicable

• Am I working in the vicinity of vehicular traffic?

  Yes

  No

  Not Applicable

• Am I performing heavy lifting using a crane or plant?

  Yes

  No

  Not Applicable

• Is there a risk I could become fatigued whilst driving?

  Yes

  No

  Not Applicable

• If you answered Yes to any of the above questions please list them in the text box below and also report to your supervisor immediately.

• Are there any other hazards? (identify hazards not covered in the JHA/SWMS or if you answered No to all questions above and are not using a JHA/SWMS)

  Yes

  No

  Not Applicable

• Enter hazard

Hazard

• Hazard Description

• Risk Rating?

  Extreme

  Very High

  High

  Moderate

  Low

• 

• Risk Controls

ASSESS AND MANAGE THE RISKS

• Assess the overall risk of the task being performed with the controls in place as noted above or in the JHA/SWMS to check whether they are effective at eliminating or minimising risk to an acceptable level

• Overall Risk Rating?

  Extreme

  Very High

  High

  Moderate

  Low

• 

• Is the risk at an acceptable level?

  Yes

  No

  N/A

• If No, contact your Supervisor to discuss alternative control measures. Reassess risk and control measures if planned work processes or work conditions change.

SIGNATURE

• Employee Signature

  Sign