SLAM (English) KAL

• Conducted on

  Date

• Prepared by

• Location
  Address

• Workplace
  Address

• Task

• Signature:

  Sign

QUESTIONS YOU HAVE TO ASK YOURSELF

• 1. Have I carried out this task before?

  YES

  NO

• 2. Do I understand working regulations/ rules for this task?

  YES

  NO

• 3. Do I have appropriate qualification, authority, permission/ PTW for this task?

  YES

  NO

• 4. Do I know all personal behavior rules in Emergencies?

  YES

  NO

• 5. Can anything fall on me? Can I drop something on someone? Can I fall down from height? Can I be hit by something?

  YES

  NO

• 6. Do my PPE comply with this task, are they in operative condition?

  YES

  NO

• 7. Have I isolated all power sources and checked reliability of blocking from unauthorized switching?

  YES

  NO

• 8. Does the equipment/tool comply with this task, are they in operative condition?

  YES

  NO

• 9. Do I know about presence of other people (equipment) at my work area and do they know about my presence at work area?

  YES

  NO

If you put Mark on red box - you MUST KNOW, in that case unmanageable hazards can occur. In such a situation turn to your supervisor! Enumerate all hazards existing on a workplace and means of their control. Write them below!

• HAZARDS

• MEANS OF CONTROL

• Notes:

If you can not control any of hazards - NEVER start the task, inform your supervisor!

• Revision 2.0 iCloud posted version is the controlled version 12/05/2018