• Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Time Take 5 Checklist completed


  • Is this task part of a Job?


  • Is there a work instruction for this task?

  • Has this task been identified in my JHA?

  • Does this task present any immediate hazards to others nearby?

  • Am I trained to do this task?


  • Have I communicated with other work groups any hazards that may affect them or me?

  • Are the controls from my JHA in place?

  • What hazards are around me "here and now"?




  • Do I have all the permits required for this task?

  • Do I have the correct tools & equipment?

  • Is the equipment isolated and I applied my red locks (if required)


  • Operator Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.