LEAD Form

• Conducted on

  Date
• Location
  Address

• Division / Work Group

• Activity

• Prepared by

Activity

• Activity (Task/Skill):

Task Understanding

• Can you please explain the steps required to perform the task? What was discussed in the pre-start meeting?

• Have all personnel completed a Take5/personal risk assessment?

  Safe

  At Risk

  N/A

• Has a pre-start meeting been conducted?

  Safe

  At Risk

  N/A

• Have all personnel been inducted and trained in the task?

  Safe

  At Risk

  N/A

• Has the SHEWMS been completed and reviewed for the task?

  Safe

  At Risk

  N/A

• Is the SHEWMS located on the job?

  Safe

  At Risk

  N/A

• Have all personnel signed on to the SHEWMS?

  Safe

  At Risk

  N/A

• Do all personnel understand the task?

  Safe

  At Risk

  N/A

• Are all the identified controls in the SHEWMS implemented?

  Safe

  At Risk

  N/A

• Are all personnel wearing the correct PPE?

  Safe

  At Risk

  N/A

• Are the correct tools being used?

  Safe

  At Risk

  N/A

• Are all personnel fit for work?

  Safe

  At Risk

  N/A

Critical Risk Protocols

• Can you tell me the risks / hazards associated with performing the task and the controls that you put in place to manage these risks / hazards?

• Asbestos

  Safe

  At Risk

  N/A

• Confined Spaces

  Safe

  At Risk

  N/A

• Chemical safety

  Safe

  At Risk

  N/A

• Crane and lifting gear

  Safe

  At Risk

  N/A

• Demolition

  Safe

  At Risk

  N/A

• Driving

  Safe

  At Risk

  N/A

• Driver Alertness

  Safe

  At Risk

  N/A

• Electrical Safety

  Safe

  At Risk

  N/A

• Energy control and isolation

  Safe

  At Risk

  N/A

• Excavation and ground penetration<br>

  Safe

  At Risk

  N/A

• Fire Protection

  Safe

  At Risk

  N/A

• Ground control and inrush

  Safe

  At Risk

  N/A

• Hotwork

  Safe

  At Risk

  N/A

• Live Traffic

  Safe

  At Risk

  N/A

• Lone and isolated workers

  Safe

  At Risk

  N/A

• Machine guarding

  Safe

  At Risk

  N/A

• Mobile elevated work platform

  Safe

  At Risk

  N/A

• Mobile plant and equipment

  Safe

  At Risk

  N/A

• Pressurised systems

  Safe

  At Risk

  N/A

• Telecommunication Towers

  Safe

  At Risk

  N/A

• Tilt up pre-cast Concrete

  Safe

  At Risk

  N/A

• Towing and recovery Welding

  Safe

  At Risk

  N/A

• Utility Services

  Safe

  At Risk

  N/A

• Working at height

  Safe

  At Risk

  N/A

• Are all the controls in place?

  Safe

  At Risk

  N/A

Managing Change

• What would you do if your work conditions (i.e environment, weather or equipment failure) or scope of work change?

• Are all workers aware of their responsibility to stop work, if conditions are unsafe?

  Safe

  At Risk

  N/A

• Can workers explain what to do if there is a change of conditions?

  Safe

  At Risk

  N/A

• Are all workers aware of the reporting process (i.e. event reporting?)

  Safe

  At Risk

  N/A

Permit to Work

• Do you require a licence or permit to conduct this task and why do you need this permit?

• Are all permits in place, filled in correctly and approved?

  Safe

  At Risk

  N/A

• Did the worker understand the need for the permit?

  Safe

  At Risk

  N/A

• Are the conditions of the permit adhered to?

  Safe

  At Risk

  N/A

Emergency Response

• Can you please explain what you would do if an incident occurs whilst performing this task?

• Is emergency equipment available and in good condition (i.e. first aid kit / spill kit)?

  Safe

  At Risk

  N/A

• • Do all personnel know where the emergency muster/evacuation point is?

  Safe

  At Risk

  N/A

• • Is there an emergency response / first aid person available on site?

  Safe

  At Risk

  N/A

• • Did the workers understand the emergency procedure?

  Safe

  At Risk

  N/A

Environment

• Have you considered any environmental factors and how are you controlling them?

• Consider the following:
  • Acid sulphate soils • Heritage • Air emissions • Noise, vibration, light • Asbestos • Pests / weeds • Chemical / spill • Waste • Community • Waterways • Flora / Fauna

• Are environmental risks documented in the take 5 / SHEWMS?

  Safe

  At Risk

  N/A

• Did the worker know where to dispose of waste correctly?

  Safe

  At Risk

  N/A

• Are the environmental controls in place?

  Safe

  At Risk

  N/A

Continual Improvement / Innovation

• Is there any suggestions for SHEQ improvement / innovations?

Signatures

Person Conducting LEAD

• Name:

• Signature:

  Sign

• Company:

• Date:

  Date

Person Interviewed

• Name:

• Signature

  Sign

• Company

• Date:

  Date

Actions: