LiveSafe Take 5x5

• Conducted on

  Date

• Prepared by

• Location
  Address

• Date:

  Date

• Name:

  Select

• Type Name

1. THINK THROUGH THE TASK

• 

• Work Plan and methods understood?

  Yes

  No

  N/A

• Has the TBRA for task been reviewed?

  Yes

  No

  N/A

• Correct PPE for Task?

  Yes

  No

  N/A

• Equipment in good order and pre-check completed?

  Yes

  No

  N/A

• Operator trained and Challenge Test completed [if applicable]?

  Yes

  No

  N/A

2. IDENTIFY THE HAZARDS

• Look above, look closely, look wide and look behind

• List the identified hazards on the reverse side of the card

3. DOES A LIFE SAVING RULE APPLY TO THE TASK?

• Bypassing Safety Controls

• • I understand and use safety-critical equipment and procedures which apply to my task
  • I obtain authorisation before:
  – disabling or overriding safety equipment
  – deviating from procedures
  – crossing a barrier

  

• Energy Isolation

• • I have identified all energy sources
  • I confirm that hazardous energy sources have been isolated, locked, and tagged
  • I have checked there is zero energy and tested for residual or stored energy

  

• Safe Mechanical Lifting

• • I confirm that the equipment and load have been inspected and are fit for purpose
  • I only operate equipment that I am qualified to use
  • I establish and obey barriers and exclusion zones
  • I never walk under a suspended load

  

• Confined Space

• • I confirm energy sources are isolated
  • I confirm the atmosphere has been tested and is monitored
  • I check and use my breathing apparatus when required
  • I confirm there is an attendant standing by
  • I confirm a rescue plan is in place
  • I obtain authorisation to enter

  

• Work Authorisation

• • I have confirmed if a permit is required
  • I am authorised to perform the work
  • I understand the permit
  • I have confirmed that hazards are controlled and it is safe to start
  • I stop and reassess if conditions change

  

• Driving

• • I always wear a seatbelt
  • I do not exceed the speed limit, and reduce my speed for road conditions
  • I do not use phones or operate devices while driving
  • I am fit, rested and fully alert while driving
  • I follow journey management requirements

  

• Line of Fire

• • I position myself to avoid:
  – moving objects
  – vehicles
  – pressure releases
  – dropped objects
  • I establish and obey barriers and exclusion zones
  • I take action to secure loose objects and report potential dropped objects

  

• Working at Height

• • I inspect my fall protection equipment before use
  • I secure tools and work materials to prevent dropped objects
  • I tie off 100% to approved anchor points while outside a protected area

  

• Hot Work

• I identify and control ignition sources
  • Before starting any hot work:
  – I confirm flammable material has been removed or isolated
  – I obtain authorisation
  • Before starting hot work in a hazardous area I confirm:
  – a gas test has been completed
  – gas will be monitored continually

  

• If Yes, confirm RULES requirements are understood and identified:

4. ASSESS THE RISK

• Refer to Risk Matrix

• 

• Likelihood x Consequence = What is the risk level?

  ACCEPTABLE

  UNDESIRABLE

  INTOLERABLE

• Identify & list individual controls on reverse of 5x5 & assess

• Review task with Supervisor for further controls prior to commencing

• Stop the Job Task not to proceed, notify Supply Base Manager

5. IMPLEMENT CONTROLS

• List and implement the controls for identified hazards on reverse of card

• Can the job be done safely?

  Yes

  No

  N/A

• If No, Stop the Job and contact your Supervisor

• If conditions change or new people join the task, conduct a new Take 5x5

Hazard, Control, Risk

• HAZARD

• CONTROL

• RISK (Level)

Hazard, Control, Risk

• HAZARD

• CONTROL

• RISK (level)