Pre-Start

• Conducted on

  Date

• Prepared by

• Location
  Address

Job Details

• Job Name

What am I doing? STOP

• Is there a SWMS for the job? Have you read it and signed off on it?

  Yes

  No

  N/A

• Am I authorised to do the job? Do I understand the job requirements?

  Yes

  No

  N/A

• Am I working around other people that can be affected by my task?

  Yes

  No

  N/A

• Am I fit for duty (free of fatigue, drugs, alcohol, physical incapacity or stress)?

  Yes

  No

  N/A

• Do I have all the necessary permits?

  Yes

  No

  N/A

What Can Go Wrong? THINK

• Do I have correct tools, equipment and PPE? Are tools in good condition and within test period?

  Yes

  No

  N/A

• Have all energy sources been identified, isolated, locked out and tagged? (Remember to test for dead)

  Yes

  No

  N/A

• Are all traffic controls in place and are they adequate? Eg Traffic, plant

  Safe

  At Risk

  N/A

• Could I be struck by something or caught in, on or between? Eg Plant, equipment

  Safe

  At Risk

  N/A

• Is it possible to slip or trip on anything, fall more than 1.8m or be hit by falling object?

  Safe

  At Risk

  N/A

• Is there the chance that I could pollute/damage/disturb the environment or community?

  Safe

  At Risk

  N/A

How can I do it safer? GO

• Have I made the required changes to eliminate or reduce the risk of the hazard?

  Yes

  No

  N/A

• Are all workers aware of the hazards associated with each task?

  Yes

  No

  N/A

• Are there any other hazards or risks that have been identified?

  Safe

  At Risk

  N/A

• Employees

• Supervisor

  Sign

• Worker 1

  Sign

• Worker 2

  Sign

• Worker 3

  Sign

• Worker 4

  Sign

• Worker 5

  Sign