RML Initial Site Take 5 V2.0

• Site conducted

  Select

• Prepared by

• Other persons working on task

• Date

  Date

• Description of work

• Site contact

• Location
  Address

• Are you fit to work today?

  Yes

  No

• How are you unfit?

• Contact your supervisor/manager.

• Do I have approval to perform this task

  Yes

  No

• Please contact your supervisor before conducting any work.

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

  Yes

  No

• Ensure you have all required equipment and that it is in good condition before undertaking your task. If this is not possible, contact your supervisor/manager.

• Have all energy sources been identified, isolated, locked out and tagged out??

  Yes

  No

• All energy sources must be isolated when being worked on. If this is not possible, discuss with your supervisor/manager.

• Are machine guards in place?

  Yes

  No

• If working without guards on a live machine, a Live Work Permit is required to be filled out daily.

• Have I inspected my work area for hazards?

  Yes

  No

• Note any hazards you can identify.

• Do I need to communicate to my surrounding workmates the risks associated with this task?

  Yes

  No

• Communicate with people working in your vicinity, explain what your task is, hazards involved and actions they need to take.

• Is there something that can fall on me or others?

  Yes

  No

  N/A

• Minimise/isolate/eliminate hazards. Note down any hazards that remain for your task, provide methods of hazard management. Provide pictures if possible.

• Can I fall from height, slip or trip on anything?

  Yes

  No

  N/A

• Minimise/isolate/eliminate hazards. Note down any hazards that remain for your task, provide methods of hazard management. Provide pictures if possible.

• Is elevated work platform (man cage) being used?

  Yes

  No

• Show equipment is in date. Ensure occupant and operators are competent as required.

• Can I be crushed or struck by any plant or machinery?

  Yes

  No

• Minimise/isolate/eliminate hazards. Note down any hazards that remain for your task, provide methods of hazard management. Provide pictures if possible.

• Do I need to read the Safety Data Sheets?

  Yes

  No

• Minimise/isolate/eliminate hazards. Note down any hazards that remain for your task, provide methods of hazard management. Provide pictures if possible.

• Are there environmental factors that could be hazardous?

  Yes

  No

• Minimise/isolate/eliminate hazards. Note down any hazards that remain for your task, provide methods of hazard management. Provide pictures if possible.

• Is there a chance that I can spill/pollute/damage/disturb the environment?

  Yes

  No

• Minimise/isolate/eliminate hazards. Note down any hazards that remain for your task, provide methods of hazard management. Provide pictures if possible.

• Has anything changed since the last time I did this task?

  Yes

  No

• Confined Space Entry Permit?

  Yes

  No

• Enter Permit# Conform to permit requirements and complete work according to safe work practice.

• Hot Work Permit?

  Yes

  No

• Enter Permit# Conform to permit requirements and complete work according to safe work practice.

• Working at heights Permit? (Scaffolding tagged)

  Yes

  No

• Enter Permit# Conform to permit requirements and complete work according to safe work practice.

• Notification of hazardous Works?

  Yes

  No

• Enter Permit# Conform to permit requirements and complete work according to safe work practice.

• Traffic Management plan?

  Yes

  No

• Enter Permit/Plan# Conform to permit requirements and complete work according to safe work practice.

• Lock Out Tag/Isolation Permit?

  Yes

  No

• Enter Permit# Conform to permit requirements and complete work according to safe work practice.

Risk Assesment Matrix

• 

• Referring to the risk matrix what is the risk score before hazard control measures?

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• What control measures are put in place?

• Referring to the risk matrix what is the risk score AFTER hazard control measures?

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• Do not proceed with this task, more hazard control is required.

• Proceed with caution.

• Supervisor Signature Required.

• Confirm that the work is safe to undertake and that all practicable steps have been taken to reduce risks.
  If there are outstanding hazards, contact your supervisor/manager.

• Employee Signature

  Sign