OZEX TAKE 5 INSPECTION

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

STOP AND THINK THROUGH THE TASK

• Is there a procedure for this task? (eg SWP, JHA, POLICY?)

  Yes

  No

• DO NOT PROCEED. COMPLETE A JHA AND DISCUSS WITH YOUR SUPERVISOR

• Is there a change to a process, procedure or design?

  Yes

  No

• DO NOT PROCEED. COMPLETE A JHA AND DISCUSS WITH YOUR SUPERVISOR

• Do I have the required permits (eg hot works, heights, confined space?)

  Yes

  No

• DO NOT PROCEED. COMPLETE A JHA AND DISCUSS WITH YOUR SUPERVISOR

• Am I trained, competent and authorised for this task?

  Yes

  No

• DO NOT PROCEED. COMPLETE A JHA AND DISCUSS WITH YOUR SUPERVISOR

• Do I have the correct PPE and equipment for this task?

  Yes

  No

• DO NOT PROCEED. COMPLETE A JHA AND DISCUSS WITH YOUR SUPERVISOR

• Do I have a clear plan in mind?

  Yes

  No

• DO NOT PROCEED. COMPLETE A JHA AND DISCUSS WITH YOUR SUPERVISOR

IDENTIFY THE HAZARDS

• Do I have to isolate to control sources of energy? (electrical, fuel etc)

  Safe

  At Risk

  N/A

• Am I fit to perform this task (aware, rested, alert)?

  Safe

  At Risk

  N/A

• Could current weather/environmental conditions affect this task?

  Safe

  At Risk

  N/A

• Could this task introduce hazards to others or damage equipment?

  Safe

  At Risk

  N/A

• Could this task impact on the environment or cultural heritage?

  Safe

  At Risk

  N/A

• Is the work area neat and tidy? (clear access and egress)?

  Safe

  At Risk

  N/A

• Can I slip, trip or fall?

  Safe

  At Risk

  N/A

• Can I strain or over-exert myself?

  Safe

  At Risk

  N/A

• Can I be caught in, or, or between anything?

  Safe

  At Risk

  N/A

• Can something fall on/strike me or others?

  Safe

  At Risk

  N/A

• Have I looked close, wide, above and below the task area?

  Safe

  At Risk

  N/A

• Do I need help to do this task?

  Safe

  At Risk

  N/A

• Do I understand the directions given by my supervisor/the procedure?

  Safe

  At Risk

  N/A

• Are there any other hazards associated with this task?

  Safe

  At Risk

  N/A

If you answered AT RISK to any of the previous questions, please add further information below

• Describe the HAZARD clearly

• Please complete the Risk Assessment in the next section. If you have not been trained to complete one, ask your Supervisor for help.

• Do you want to review the Risk Matrix Template?

  Yes

  No

• 

• What is the LIKELIHOOD of this occuring? (1-5, 1 being unlikely, 5 highly likely)

• What is the severity of this event? (1 = not serious, 5 = catastrophic)

• What controls will you put in place to reduce the risk?

• Now the controls are in place, what is the LIKELIHOOD of this event occuring? (1-5, 1 being unlikely, 5 being highly likely)

• Now the controls are in place, what is the severity of this event occuring? (1 = not serious, 5 = catastrophic)

• Multiply the CONTROLLED LIKELIHOOD by the CONTROLLED SEVERITY. (1 to 25)

• DO NOT PROCEED WITH THE TASK. INFORM YOUR SUPERVISOR

• Proceed with caution