P&O Take 5

• Name of Task

• Vessel / Site

• Conducted on

  Date

• Conducted by

• Location
  Address

• Personnel involved

STOP AND THINK ABOUT THE TASK

• Do I/we fully understand the task and procedure?

  Yes

  No

• Does this task require a permit to work?

  Yes

  No

• Do I/we need approval to do this?

  Yes

  No

• Is the equipment in good working order and appropriate for this task?

  Yes

  No

THINK ABOUT THE HAZARDS AND CONTROLS

• Can I slip, trip or fall on or into anything?

  Yes

  No

• Enter control(s) for this hazard (if applicable)

• Can I strain or over exert myself?

  Yes

  No

• Enter control(s) for this hazard (if applicable)

• Can I be caught in anything (eg. hands, feet, clothing)?

  Yes

  No

• Enter control(s) for this hazard (if applicable)

• Can something fall on me?

  Yes

  No

• Enter control(s) for this hazard (if applicable)

• Are there any other hazards?

  Yes

  No

• What are the other hazards (if any)? List them

• What are the additional controls (if any)? List them

ARE CONTROLS SUFFICIENT?

• If NO, please consult your supervisor as a Risk Assessment may be required

  Yes

  No

• If YES, then checking the box means I/we have carefully thought about the task, its hazards and controls

• Operator Signature

  Sign