Title Page

  • Conducted on

  • Location
  • Division / Work Group

  • Activity

  • Prepared by

Activity

Activity

  • Activity (Task/Skill):

Task Understanding

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?

  • Has a pre-start meeting been conducted?

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

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

  • Is the SHEWMS located on the job?

  • Have all personnel signed on to the SHEWMS?

  • Do all personnel understand the task?

  • Are all the identified controls in the SHEWMS implemented?

  • Are all personnel wearing the correct PPE?

  • Are the correct tools being used?

  • Are all personnel fit for work?

Critical Risk Protocols

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

  • Confined Spaces

  • Chemical safety

  • Crane and lifting gear

  • Demolition

  • Driving

  • Driver Alertness

  • Electrical Safety

  • Energy control and isolation

  • Excavation and ground penetration<br>

  • Fire Protection

  • Ground control and inrush

  • Hotwork

  • Live Traffic

  • Lone and isolated workers

  • Machine guarding

  • Mobile elevated work platform

  • Mobile plant and equipment

  • Pressurised systems

  • Telecommunication Towers

  • Tilt up pre-cast Concrete

  • Towing and recovery Welding

  • Utility Services

  • Working at height

  • Are all the controls in place?

Managing Change

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?

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

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

Permit to Work

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?

  • Did the worker understand the need for the permit?

  • Are the conditions of the permit adhered to?

Emergency Response

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)?

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

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

  • • Did the workers understand the emergency procedure?

Environment

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?

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

  • Are the environmental controls in place?

Continual Improvement

Continual Improvement / Innovation

  • Is there any suggestions for SHEQ improvement / innovations?

Signatures

Signatures

Person Conducting LEAD

  • Name:

  • Signature:

  • Company:

  • Date:

Person Interviewed

  • Name:

  • Signature

  • Company

  • Date:

Actions

Actions:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.