Title Page

  • Conducted on

  • Prepared by

  • Location
  • Tasks

  • Team Members

1. High Risk Activities

High Risk Work Activities

  • 1.1 High risk work activities

  • Do you have a SWMS / risk assessment that covers the risk of fall greater than 2m?

  • By checking this box, I am confirming that I have completed a SWMS / risk assessment for the risk of fall greater than 2m and if required I have added actions or notes to this question.

  • Do you have a SWMS / risk assessment that covers the demolition of a load bearing structure?

  • By checking this box, I am confirming that I have completed a SWMS / risk assessment that covers the demolition of a load bearing structure and if required I have added actions or notes to this question.

  • Do you have a SWMS / risk assessment that covers the disturbance of asbestos?

  • By checking this box, I am confirming that I have completed a SWMS / risk assessment that covers the disturbance of asbestos and if required I have added actions or notes to this question.

  • Do you have a SWMS / risk assessment that covers the safe use of temporary support to prevent collapse?

  • By checking this box, I am confirming that I have completed a SWMS / risk assessment the safe use of temporary support to prevent collapse and if required I have added actions or notes to this question.

  • Do you have a SWMS / risk assessment for the confined space?

  • By checking this box, I am confirming that I have completed a SWMS / risk assessment for the confined space and if required I have added actions or notes to this question.

  • Do you have a SWMS / risk assessment for working in or near a shaft, tunnel or trench deeper than 1.5m?

  • By checking this box, I am confirming that I have completed a SWMS / risk assessment for working in or near a shaft, tunnel or trench deeper than 1.5m and if required I have added actions or notes to this question.

  • Do you have a SWMS / risk assessment for working on or near pressurized gas mains or piping?

  • By checking this box, I am confirming that I have completed a SWMS / risk assessment for working on or near pressurized gas mains or piping and if required I have added actions or notes to this question.

  • Do you have a SWMS / risk assessment for working on or near chemicals, fuel or refrigerant lines?

  • By checking this box, I am confirming that I have completed a SWMS / risk assessment for working on or near chemicals, fuel or refrigerant lines and if required I have added actions or notes to this question.

  • Do you have a SWMS / risk assessment for working on or near the energised electrical installation?

  • By checking this box, I am confirming that I have completed a SWMS / risk assessment for working on or near the energised electrical installation and if required I have added actions or notes to this question.

  • Do you have a SWMS / risk assessment for working in a contaminated or flammable atmosphere?

  • By checking this box, I am confirming that I have completed a SWMS / risk assessment for working in a contaminated or flammable atmosphere and if required I have added actions or notes to this question.

  • Do you have a SWMS / risk assessment for working on, in or adjacent to the traffic corridor?

  • By checking this box, I am confirming that I have completed a SWMS / risk assessment for working on, in or adjacent to the traffic corridor and if required I have added actions or notes to this question.

  • Do you have a SWMS / risk assessment for working in the vicinity of powered mobile plant?

  • By checking this box, I am confirming that I have completed a SWMS / risk assessment for working in the vicinity of powered mobile plant and if required I have added actions or notes to this question.

  • Do you have a SWMS / risk assessment for working in the artificial extremes of temperature?

  • By checking this box, I am confirming that I have completed a SWMS / risk assessment for working in the artificial extremes of temperature and if required I have added actions or notes to this question.

  • Do you have a SWMS / risk assessment for working in or near liquid where there is a risk of drowning?

  • By checking this box, I am confirming that I have completed a SWMS / risk assessment for working in or near liquid, where there is a risk of drowning, and if required I have added actions or notes to this question.

  • Move onto section 2

2. Stop and Think

Stop and Think

  • 2.1 Do I understand what I need to do?

  • DO NOT START WORK. By checking this box you are confirming that you have notified your JCU Rep / Manager and you now understand what you need to do.

  • 2.2 Do I have all the permit I require?

  • DO NOT START WORK. By checking this box, you are confirming that you have contacted the JCU Rep / Manager and you now have all of the correct permits in place.

  • 2.3 Are the right people / tools / equipment / PPE available?

  • DO NOT START WORK source equipment/tools/PPE or review the risk assessment to determine alternative controls. By checking this box I am confirming that the right tools / equipment / PPE are available.

  • 2.4 Is there a SWP / guideline / SWMS / risk assessment?

  • DO NOT START WORK. By checking this box I am confirming that I have a SWP / guideline / SWMS / risk assessment applicable to the work.

  • 2.5 Can I conduct the work in accordance with the SWP / guideline / SWMS / risk assessment?

  • DO NOT START WORK. By checking this box I am confirming that I can follow all controls in the SWP / guideline / SWMS / risk assessment or I have reassessed the risks and controls and recorded these changes.

  • 2.6 Have I communicated with other workers any hazards that may affect me or them?

  • DO NOT START WORK. By checking this box I am confirming that I have now communicated hazards to all workers who may be affected by them.

  • 2.7 Am I trained / qualified and competent to do this work?

  • DO NOT START WORK source equipment/tools/PPE or review the risk assessment to determine alternative controls. By checking this box I am confirming that the right tools / equipment / PPE are available.

  • 2.8 Is supervision (if required) available?

  • DO NOT START WORK until the correct supervision is in place. By checking this box I am confirming that supervision is appropriate for the work.

  • 2.9 Will others nearby be safe during my work?

  • DO NOT START WORK. By checking this box I am confirming that I have reassess my work practices and all controls will now ensure others nearby will be safe during my work.

  • 2.10 Do I understand what to do in an emergency?

  • DO NOT START WORK. By checking this box I am confirming that I have contacted the JCU Rep / Manager and I now understand what to do in an emergency.

  • 2.11 Have I done everything possible to minimise the risk?

  • DO NOT START WORK. By checking this box I am confirming that everything possible has now been taken to minimise the risk.

  • 2.12 Am I fit to do the work (i.e. free from fatigue, alcohol / drugs, medical illness, etc.)?

  • WORKERS WHO ARE UNFIT TO DO THE WORK MUST NOT START WORK. By checking this box I am confirming that I am now fit to do the work.

  • 2.13 Is it safe to complete this task in the current weather / environmental conditions?

  • DO NOT START WORK. By checking this box you are confirming that the weather/environmental conditions are now suitable to conduct the work or controls have been implemented to allow part/all of the activities to continue (add controls to the action / notes for this question).

  • 2.14 Are all hazards controlled?

  • DO NOT START WORK. By checking this box you are confirming that all hazards are now controlled.

3. Hazards and Controls

  • Select the hazards that apply to this work.

  • Manual tasks hazard controls

  • Gravity hazard controls

  • Radiation hazard controls

  • Electrical hazard controls

  • High pressure hazard controls

  • Working alone controls

  • Biological hazard controls

  • Machinery and equipment hazard controls

  • Chemical hazard controls

  • Heat / cold hazard controls

  • Noise hazard controls

  • Hot work hazard controls

  • Additional hazards and controls

4. Is it SAFE to start work?

Is it safe to start work?

  • JCU Risk Matrix

    Risk matrix.JPG
  • Using the JCU risk matrix, the overall risk level for this work with controls in place (current risk level) is?

  • Acceptable Level of Risk, START WORK

  • By checking this box you are confirming that all reasonably practicable controls are being used and the JCU Rep / Manager has agreed that this level of risk is acceptable. START WORK.

  • DO NOT START WORK. The current level of risk is unacceptable. If the level of risk can not be reduced to medium or low, contact the JCU Rep / Manager for further direction.

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.