Take 5 Checklist

  • Am i fit for the job?

  • How are you unfit?

  • Contact your supervisor/manager.

  • Do I have approval to perform this task

  • Who is able to give approval for this task?

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

  • 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??

  • 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?

  • 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?

  • Note any hazards you can identify.

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

  • 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?

  • 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?

  • 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?

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

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

  • 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?

  • 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?

  • 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?

  • 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?

Are Permits Required?

  • Confined Space Entry Permit?

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

  • Hot Work Permit?

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

  • Working at heights Permit? (Scaffolding tagged)

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

  • Notification of hazardous Works?

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

  • Traffic Management plan?

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

  • Lock Out Tag/Isolation Permit?

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

Sign Off

  • 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

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