Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

STOP AND THINK THROUGH THE TASK

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

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

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

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

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

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

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

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

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

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

  • Do I have a clear plan in mind?

  • 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)

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

  • Could current weather/environmental conditions affect this task?

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

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

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

  • Can I slip, trip or fall?

  • Can I strain or over-exert myself?

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

  • Can something fall on/strike me or others?

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

  • Do I need help to do this task?

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

  • 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

  • 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.

Risk Assessment

  • Do you want to review the Risk Matrix Template?

  • A-standard-risk-matrix.png
  • 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

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.