Safety (Take 5)

• Client / Site

• Prepared by

• Conducted on

  Date

• Document No.

• Task Description:

• Task Leader:

• Select date

  Date
• Add location
  Address

• Risk with controls:

  Select Low Medium High Critical

  • Low
  • Medium
  • High
  • Critical

• Permit Required?

  Yes

  No

  N/A

Task

• Stop and think through the task.

• Are you fit to perform the required task?

• Do you understand the job has it been explained sufficiently?

• Are you competent to do the work and familiar with the equipment?

• Are the tools and equipment in safe condition?

• Do you have a standard SWP or JHA for the task?

• Have you informed others that may be affected by your work?

Access the Work

• Does the task involve any of the following?

• Equipment Isolation?

• Confined Space Work?

• Working at Heights?

• Use of cranes or lifting devices?

• Use of mobile equipment?

• Ground Distrubance?

• Assistance from others?

• Use of barricades?

• Communication in noisy areas or with others?

• Potential environmental impacts?

Find the energies

• Look up/down/beside can I be exposed to:

• Vehicles?

• Description:

• Gravity?

• Description:

• Human?

• Description:

• Electrical?

• Description:

• Mechanical?

• Description:

• Vibrational?

• Description:

• Mechanical?

• Description:

• Hazardous Atmosphere?

• Description:

• Chemical?

• Description:

• Thermal?

• Description:

• Pressurised Systems?

• Description:

• Radiation?

• Description:

• Flying objects?

• Description:

• Other?

• Description:

• Employee Signature

  Sign

• Safety Advisor/Supervisor/Senior Management Signature

  Sign

Email copy to luke@innovativeas.com.au for storage in OHSE registry