Jacky McLean

McWilkys: Stop - Take 5

Stop - Take 5 Safety Form

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Use this Template

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Information

Document No.
Job Number
Conducted on
Location
Personnel

Check:

Are all energy sources isolated?
Does machinery have guarding?
Is this task safe from a fall from height?
Is it clear from people above or below?
Are the tools right for the job?
Are tools in safe working condition?
Is my task free from hurting others?
Is it free from possibility of sustaining a strain or sprain?
Is it free from confined space work?

Am I free from exposure to:

Am I free from exposure to:
Noise
Hazardous substances
Thermal stress (heat/cold)
Vibration / radiation
Gas / fumes / dust
Moving traffic
Working with suspended load
Have the hazards identified been controlled?
Insert Signature

Jacky McLean

McWilkys: Stop - Take 5

Stop - Take 5 Safety Form

Use this Template

Print as PDF

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.