Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
STOP AND THINK THROUGH THE TASK
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Is there a procedure for this task? (eg SWP, JHA, POLICY?)
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DO NOT PROCEED. COMPLETE A JHA AND DISCUSS WITH YOUR SUPERVISOR
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Is there a change to a process, procedure or design?
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DO NOT PROCEED. COMPLETE A JHA AND DISCUSS WITH YOUR SUPERVISOR
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Do I have the required permits (eg hot works, heights, confined space?)
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DO NOT PROCEED. COMPLETE A JHA AND DISCUSS WITH YOUR SUPERVISOR
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Am I trained, competent and authorised for this task?
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DO NOT PROCEED. COMPLETE A JHA AND DISCUSS WITH YOUR SUPERVISOR
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Do I have the correct PPE and equipment for this task?
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DO NOT PROCEED. COMPLETE A JHA AND DISCUSS WITH YOUR SUPERVISOR
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Do I have a clear plan in mind?
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DO NOT PROCEED. COMPLETE A JHA AND DISCUSS WITH YOUR SUPERVISOR
IDENTIFY THE HAZARDS
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Do I have to isolate to control sources of energy? (electrical, fuel etc)
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Am I fit to perform this task (aware, rested, alert)?
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Could current weather/environmental conditions affect this task?
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Could this task introduce hazards to others or damage equipment?
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Could this task impact on the environment or cultural heritage?
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Is the work area neat and tidy? (clear access and egress)?
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Can I slip, trip or fall?
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Can I strain or over-exert myself?
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Can I be caught in, or, or between anything?
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Can something fall on/strike me or others?
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Have I looked close, wide, above and below the task area?
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Do I need help to do this task?
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Do I understand the directions given by my supervisor/the procedure?
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Are there any other hazards associated with this task?
If you answered AT RISK to any of the previous questions, please add further information below
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Describe the HAZARD clearly
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Please complete the Risk Assessment in the next section. If you have not been trained to complete one, ask your Supervisor for help.
Risk Assessment
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Do you want to review the Risk Matrix Template?
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What is the LIKELIHOOD of this occuring? (1-5, 1 being unlikely, 5 highly likely)
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What is the severity of this event? (1 = not serious, 5 = catastrophic)
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What controls will you put in place to reduce the risk?
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Now the controls are in place, what is the LIKELIHOOD of this event occuring? (1-5, 1 being unlikely, 5 being highly likely)
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Now the controls are in place, what is the severity of this event occuring? (1 = not serious, 5 = catastrophic)
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Multiply the CONTROLLED LIKELIHOOD by the CONTROLLED SEVERITY. (1 to 25)
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DO NOT PROCEED WITH THE TASK. INFORM YOUR SUPERVISOR
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Proceed with caution
