PFM Take 5

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Job number

• Customer

• Describe the job / task

Identify the Hazards

• Am I fit for work

  Yes

  No

• Could Asbestos be present or disturbed by completing the job / task

  No

  Yes

• Do I understand the task / job and equipment to be use

  Yes

  No

• Could I slip or trip on anything

  No

  Yes

• Am I competent / authorised for this task

  Yes

  No

• Could I fall from height

  No

  Yes

• Are all tools and equipment fit for purpose

  Yes

  No

• Will my task put anyone else at a safety risk

  No

  Yes

• Is the work area adequate for the task

  No

  Yes

• Could I be caught in or between anything

  No

  Yes

• Have I identified all STORED energies ? <br>(Electricity, Hydraulic, Pneumatic)

  Yes

  No

• Could I strain or over exert myself

  No

  Yes

• Is there a SOP / SWP / SWMS for the task

  Yes

  No

• Do I need to enter "confined space"

  No

  Yes

• Am I protected from the effects of weather and climate

  Yes

  No

• Will the activities of others in the area affect me

  No

  Yes

• Have all hazards & controls been incentivised within this Take 5?
  
  IF ANY QUESTIONS ARE RED CONDUCT A FORMAL RISK ASSESSMENT OF THE JOB / TASK

Hazard Identification

• Describe the HAZARD : how can you be hurt doing this task

• Document the CONTROLS to be implemented : what will be done about the hazard/s

• By Who

• By When

• Residual risk rating ( Likelihood / Consequence )

  Select Nearly Certain / Extreme - 25 Nearly Certain / High - 23 Nearly Certain / Medium - 20 Nearly Certain / Low - 16 Nearly Certain / Negligible - 11 Probable / Extreme - 24 Probable / High - 21 Probable / Medium - 17 Probable / Low - 12 Probable / Negligible - 7 Possible / Extreme - 22 Possible / High - 18 Possible / Medium - 13 Possible / Low - 8 Possible / Negligible - 4 Unlikely / Extreme - 19 Unlikely / High - 14 Unlikely / Medium - 9 Unlikely / Low - 5 Unlikely / Negligible - 2 Rare / Extreme - 15 Rare / High - 10 Rare / Medium - 6 Rare / Low - 3 Rare / Negligible - 1

  • Nearly Certain / Extreme - 25
  • Nearly Certain / High - 23
  • Nearly Certain / Medium - 20
  • Nearly Certain / Low - 16
  • Nearly Certain / Negligible - 11
  • Probable / Extreme - 24
  • Probable / High - 21
  • Probable / Medium - 17
  • Probable / Low - 12
  • Probable / Negligible - 7
  • Possible / Extreme - 22
  • Possible / High - 18
  • Possible / Medium - 13
  • Possible / Low - 8
  • Possible / Negligible - 4
  • Unlikely / Extreme - 19
  • Unlikely / High - 14
  • Unlikely / Medium - 9
  • Unlikely / Low - 5
  • Unlikely / Negligible - 2
  • Rare / Extreme - 15
  • Rare / High - 10
  • Rare / Medium - 6
  • Rare / Low - 3
  • Rare / Negligible - 1

• Describe the HAZARD : how can you be hurt doing this task

• Document the CONTROLS to be implemented : what will be done about the hazard/s

• Residual risk rating ( Likelihood / Consequence )

  Select Nearly Certain / Extreme - 25 Nearly Certain / High - 23 Nearly Certain / Medium - 20 Nearly Certain / Low - 16 Nearly Certain / Negligible - 11 Probable / Extreme - 24 Probable / High - 21 Probable / Medium - 17 Probable / Low - 12 Probable / Negligible - 7 Possible / Extreme - 22 Possible / High - 18 Possible / Medium - 13 Possible / Low - 8 Possible / Negligible - 4 Unlikely / Extreme - 19 Unlikely / High - 14 Unlikely / Medium - 9 Unlikely / Low - 5 Unlikely / Negligible - 2 Rare / Extreme - 15 Rare / High - 10 Rare / Medium - 6 Rare / Low - 3 Rare / Negligible - 1

  • Nearly Certain / Extreme - 25
  • Nearly Certain / High - 23
  • Nearly Certain / Medium - 20
  • Nearly Certain / Low - 16
  • Nearly Certain / Negligible - 11
  • Probable / Extreme - 24
  • Probable / High - 21
  • Probable / Medium - 17
  • Probable / Low - 12
  • Probable / Negligible - 7
  • Possible / Extreme - 22
  • Possible / High - 18
  • Possible / Medium - 13
  • Possible / Low - 8
  • Possible / Negligible - 4
  • Unlikely / Extreme - 19
  • Unlikely / High - 14
  • Unlikely / Medium - 9
  • Unlikely / Low - 5
  • Unlikely / Negligible - 2
  • Rare / Extreme - 15
  • Rare / High - 10
  • Rare / Medium - 6
  • Rare / Low - 3
  • Rare / Negligible - 1

• Describe the HAZARD : how can you be hurt doing this task

• Document the CONTROLS to be implemented : what will be done about the hazard/s

• Residual risk rating ( Likelihood / Consequence )

  Select Nearly Certain / Extreme - 25 Nearly Certain / High - 23 Nearly Certain / Medium - 20 Nearly Certain / Low - 16 Nearly Certain / Negligible - 11 Probable / Extreme - 24 Probable / High - 21 Probable / Medium - 17 Probable / Low - 12 Probable / Negligible - 7 Possible / Extreme - 22 Possible / High - 18 Possible / Medium - 13 Possible / Low - 8 Possible / Negligible - 4 Unlikely / Extreme - 19 Unlikely / High - 14 Unlikely / Medium - 9 Unlikely / Low - 5 Unlikely / Negligible - 2 Rare / Extreme - 15 Rare / High - 10 Rare / Medium - 6 Rare / Low - 3 Rare / Negligible - 1

  • Nearly Certain / Extreme - 25
  • Nearly Certain / High - 23
  • Nearly Certain / Medium - 20
  • Nearly Certain / Low - 16
  • Nearly Certain / Negligible - 11
  • Probable / Extreme - 24
  • Probable / High - 21
  • Probable / Medium - 17
  • Probable / Low - 12
  • Probable / Negligible - 7
  • Possible / Extreme - 22
  • Possible / High - 18
  • Possible / Medium - 13
  • Possible / Low - 8
  • Possible / Negligible - 4
  • Unlikely / Extreme - 19
  • Unlikely / High - 14
  • Unlikely / Medium - 9
  • Unlikely / Low - 5
  • Unlikely / Negligible - 2
  • Rare / Extreme - 15
  • Rare / High - 10
  • Rare / Medium - 6
  • Rare / Low - 3
  • Rare / Negligible - 1

• Describe the HAZARD : how can you be hurt doing this task

• Document the CONTROLS to be implemented : what will be done about the hazard/s

• Residual risk rating ( Likelihood / Consequence )

  Select Nearly Certain / Extreme - 25 Nearly Certain / High - 23 Nearly Certain / Medium - 20 Nearly Certain / Low - 16 Nearly Certain / Negligible - 11 Probable / Extreme - 24 Probable / High - 21 Probable / Medium - 17 Probable / Low - 12 Probable / Negligible - 7 Possible / Extreme - 22 Possible / High - 18 Possible / Medium - 13 Possible / Low - 8 Possible / Negligible - 4 Unlikely / Extreme - 19 Unlikely / High - 14 Unlikely / Medium - 9 Unlikely / Low - 5 Unlikely / Negligible - 2 Rare / Extreme - 15 Rare / High - 10 Rare / Medium - 6 Rare / Low - 3 Rare / Negligible - 1

  • Nearly Certain / Extreme - 25
  • Nearly Certain / High - 23
  • Nearly Certain / Medium - 20
  • Nearly Certain / Low - 16
  • Nearly Certain / Negligible - 11
  • Probable / Extreme - 24
  • Probable / High - 21
  • Probable / Medium - 17
  • Probable / Low - 12
  • Probable / Negligible - 7
  • Possible / Extreme - 22
  • Possible / High - 18
  • Possible / Medium - 13
  • Possible / Low - 8
  • Possible / Negligible - 4
  • Unlikely / Extreme - 19
  • Unlikely / High - 14
  • Unlikely / Medium - 9
  • Unlikely / Low - 5
  • Unlikely / Negligible - 2
  • Rare / Extreme - 15
  • Rare / High - 10
  • Rare / Medium - 6
  • Rare / Low - 3
  • Rare / Negligible - 1

• Describe the HAZARD : how can you be hurt doing this task

• Document the CONTROLS to be implemented : what will be done about the hazard/s

• Residual risk rating ( Likelihood / Consequence )

  Select Nearly Certain / Extreme - 25 Nearly Certain / High - 23 Nearly Certain / Medium - 20 Nearly Certain / Low - 16 Nearly Certain / Negligible - 11 Probable / Extreme - 24 Probable / High - 21 Probable / Medium - 17 Probable / Low - 12 Probable / Negligible - 7 Possible / Extreme - 22 Possible / High - 18 Possible / Medium - 13 Possible / Low - 8 Possible / Negligible - 4 Unlikely / Extreme - 19 Unlikely / High - 14 Unlikely / Medium - 9 Unlikely / Low - 5 Unlikely / Negligible - 2 Rare / Extreme - 15 Rare / High - 10 Rare / Medium - 6 Rare / Low - 3 Rare / Negligible - 1

  • Nearly Certain / Extreme - 25
  • Nearly Certain / High - 23
  • Nearly Certain / Medium - 20
  • Nearly Certain / Low - 16
  • Nearly Certain / Negligible - 11
  • Probable / Extreme - 24
  • Probable / High - 21
  • Probable / Medium - 17
  • Probable / Low - 12
  • Probable / Negligible - 7
  • Possible / Extreme - 22
  • Possible / High - 18
  • Possible / Medium - 13
  • Possible / Low - 8
  • Possible / Negligible - 4
  • Unlikely / Extreme - 19
  • Unlikely / High - 14
  • Unlikely / Medium - 9
  • Unlikely / Low - 5
  • Unlikely / Negligible - 2
  • Rare / Extreme - 15
  • Rare / High - 10
  • Rare / Medium - 6
  • Rare / Low - 3
  • Rare / Negligible - 1

• Describe the HAZARD : how can you be hurt doing this task

• Document the CONTROLS to be implemented : what will be done about the hazard/s

• Residual risk rating ( Likelihood / Consequence )

  Select Nearly Certain / Extreme - 25 Nearly Certain / High - 23 Nearly Certain / Medium - 20 Nearly Certain / Low - 16 Nearly Certain / Negligible - 11 Probable / Extreme - 24 Probable / High - 21 Probable / Medium - 17 Probable / Low - 12 Probable / Negligible - 7 Possible / Extreme - 22 Possible / High - 18 Possible / Medium - 13 Possible / Low - 8 Possible / Negligible - 4 Unlikely / Extreme - 19 Unlikely / High - 14 Unlikely / Medium - 9 Unlikely / Low - 5 Unlikely / Negligible - 2 Rare / Extreme - 15 Rare / High - 10 Rare / Medium - 6 Rare / Low - 3 Rare / Negligible - 1

  • Nearly Certain / Extreme - 25
  • Nearly Certain / High - 23
  • Nearly Certain / Medium - 20
  • Nearly Certain / Low - 16
  • Nearly Certain / Negligible - 11
  • Probable / Extreme - 24
  • Probable / High - 21
  • Probable / Medium - 17
  • Probable / Low - 12
  • Probable / Negligible - 7
  • Possible / Extreme - 22
  • Possible / High - 18
  • Possible / Medium - 13
  • Possible / Low - 8
  • Possible / Negligible - 4
  • Unlikely / Extreme - 19
  • Unlikely / High - 14
  • Unlikely / Medium - 9
  • Unlikely / Low - 5
  • Unlikely / Negligible - 2
  • Rare / Extreme - 15
  • Rare / High - 10
  • Rare / Medium - 6
  • Rare / Low - 3
  • Rare / Negligible - 1

Completed by (list all involved in task)

• Name

• Signed

  Sign

• Name

• Signed

  Sign

• Name

• Signed

  Sign

• Name

• Signed

  Sign