Title Page
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Conducted on
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Prepared by
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Location
Job Details
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Job Name
What am I doing? STOP
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Is there a SWMS for the job? Have you read it and signed off on it?
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Am I authorised to do the job? Do I understand the job requirements?
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Am I working around other people that can be affected by my task?
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Am I fit for duty (free of fatigue, drugs, alcohol, physical incapacity or stress)?
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Do I have all the necessary permits?
What Can Go Wrong? THINK
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Do I have correct tools, equipment and PPE? Are tools in good condition and within test period?
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Have all energy sources been identified, isolated, locked out and tagged? (Remember to test for dead)
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Are all traffic controls in place and are they adequate? Eg Traffic, plant
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Could I be struck by something or caught in, on or between? Eg Plant, equipment
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Is it possible to slip or trip on anything, fall more than 1.8m or be hit by falling object?
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Is there the chance that I could pollute/damage/disturb the environment or community?
How can I do it safer? GO
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Have I made the required changes to eliminate or reduce the risk of the hazard?
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Are all workers aware of the hazards associated with each task?
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Are there any other hazards or risks that have been identified?
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Employees
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Supervisor
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Worker 1
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Worker 2
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Worker 3
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Worker 4
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Worker 5