ProQuip: Take 5 Risk Assessment

• 1. Stop and Think: Plan the task.

• 2. Identify: Identify the hazards and risks involved

• 3. Assess: Assess the level of risk involved

• 4. Implement Controls: Control the hazards and risks

• 5. Carry Out The Task Safely

• Risk Matrix:

  

TAKE 5 ASSESSMENT

• Work Order Number

• Conducted On

  Date

• Prepared By

• Location Task is Being Performed
  Address

• Safe Work Method Statement Completed

  Yes

  No

  N/A

• Do not commence work until a Safe Work Method Statement has been completed.

• I understand the task(s) that need to be undertaken and completed.

  Yes

  No

  N/A

• Do not commence any tasks until you fully understand what is required to be completed.

• PERMIT: Is a Permit required for this task(s).

  Yes

  No

  N/A

• Obtain required Permit(s) prior to commencing work.

• PPE: Correct PPE is being worn and in good condition.

  Yes

  No

  N/A

• Do not commence work without wearing the correct PPE.

• TOOLING: I have the correct tooling for the Task(s).

  Yes

  No

  N/A

• Ensure correct tooling is obtained prior to commencing or continuing the task(s).

• SLIPS & TRIPS: I have inspected the work area and and removed all slip and trip hazards.

  Yes

  No

  N/A

• Clear all trip and slip hazards from the site before commencing work.

• FALLS: Can I fall from a height.

  Yes

  No

  N/A

• Ensure controls are in place. Do not commence work until controls are implemented.

• CRUSHING: Can I be caught in or between anything, or can anything fall on me.

  Yes

  No

  N/A

• Ensure controls are in place. Do not commence work until controls are implemented.

• ENVIRONMENTAL: Have environmental factors been addressed. Chemical, Exposure.

  Yes

  No

  N/A

• Ensure environmental risk controls are in place. Do not commence work until controls are implimented.

• BIOLOGICAL: I am not exposed to biological hazards and risks.

  Yes

  No

  N/A

• Ensure controls are in place for all identified hazards and risks prior to commencing work.

• ACOUSTIC: I am not exposed to excessive noise or prolonged noise.

  Yes

  No

  N/A

• Before commencing the task put the appropriate controls in place.

• MANUAL HANDLING: Can I strain or over exert myself.

  Yes

  No

  N/A

• Seek additional assistance for the task(s) - Do not commence until controls are in place.

• ELECTRICAL: Does a risk of electrocution or electrical shock exist.

  Yes

  No

  N/A

• Ensure electrical risk controls are in place Do not commence work until controls are implemented.

• TEMPERATURE: No extreme temperatures exist. Heat burns, cold burns.

  Yes

  No

  N/A

• Put controls in place to eliminate the risk of burns.

• WEATHER: Weather conditions are suitable for the task(s) to be completed.

  Yes

  No

  N/A

• Put controls in place to avoid working in adverse weather conditions. Delay the task(s) if required. Contact your Supervisor.

• PSYCHOLOGICAL: Stress, fatigue, violence, depression.

  Yes

  No

  N/A

• Do not commence work. Contact you Supervisor and discuss psychological conditions prior to commencing work.

• Isolation or tagging is in place.

  Yes

  No

  N/A

• Ensure isolation or tagging has been implemented as per Proquip Safety Procedure PS-001.

• I have the correct licenses and competencies to carry out the task(s).

  Yes

  No

  N/A

• Do not commence any task(s) that you do not hold licenses or competencies for. Contact your immediate Supervisor.

• All identified hazards and risks have controls in place.

  Yes

  No

  N/A

• Ensure controls are in place for all identified hazards and risks prior to commencing work. Contact your Supervisor if you are unable to put the required controls in place.

• Identified Hazards:

• List the Controls:

• I feel safe to commence the task(s).

  Yes

  No

  N/A

• Contact your Supervisor to discuss the tasks and risks. Do not commence any tasks until all concerns are addressed and controls are implemented.

• Safe to Commence the Task(s):

  Sign

• Photograph of Work Area:

  Media