Information

  • Work Order number

  • Take 5 Safety@Spotless

  • Conducted on

  • Name

  • Address

1.STOP

  • Is this a ROUTINE Task?

  • HAZARD

  • CONTROLS

  • RISK SCORE

  • Have I read and understood the Safe Work Procedure (SWP) for this task?

  • HAZARDS

  • CONTROLS

  • RISK SCORE

  • Does this task require JSA/Permit?

  • HAZARD

  • CONTROLS

  • RISK SCORE

  • Have I inspected the work area?

  • HAZARD

  • CONTROLS

  • RISK SCORE

  • HAZARD

  • CONTROLS

  • RISK SCORE

  • Are the tools/equipment 'Fit For Purpose'?

  • HAZARD

  • CONTROLS

  • RISK SCORE

  • Am I trained and competent to complete the Task?

  • HAZARD

  • CONTROLS

  • RISK SCORE

  • Do I have the right PPE for this task?

  • HAZARD

  • CONTROLS

  • RISK SCORE

2. THINK ABOUT AND LOOK FOR HAZARDS

  • Have I completed the pre-start check list for any pieces of the equipment?

  • HAZARD

  • CONTROLS

  • RISK SCORE

  • Do I have the correct equipment when/if working with sharps?<br>(eg. Knives, carton cutters, broken crockery)

  • HAZARD

  • CONTROLS

  • RISK SCORE

  • Do I require an observer for the task?

  • HAZARD

  • CONTROLS

  • RISK SCORE

  • Is there a way I could get my hand or any pieces of clothing trapped or caught in equipment or environment?

  • HAZARD

  • CONTROLS

  • RISK SCORE

  • Do I need to use a chemical substances or likely to be exposed to one?

  • HAZARD

  • CONTROLS

  • RISK SCORE

  • I know how to use chemical safely and how to manage a spill?

  • HAZARD

  • CONTROLS

  • RISK SCORE

  • Will the task involve interaction with other workers or workgroups?

  • HAZARD

  • CONTROLS

  • RISK SCORE

  • Does the task require me to do any hazardous manual tasking?<br>(eg repetitive movement, lifting or manoeuvring loads, awkward or static postures)

  • HAZARD

  • CONTROLS

  • RISK SCORE

  • HAZARD

  • CONTROLS

  • RISK SCORE

  • HAZARD

  • CONTROLS

  • RISK SCORE

  • HAZARD

  • CONTROLS

  • RISK SCORE

  • Will this task take longer than 1 hour, without any changes?<br>(if so, you will need to consider task organization)

  • HAZARD

  • CONTROLS

  • RISK SCORE

RESPOND

  • Have I established all necessary controls?

  • Name/s of worker involved in the task

  • Signature

  • STOP WORK AND INFORM YOUR SUPERVISOR OR MANAGER. REMEMBER - IF ITS NOT SAFE DON`T DO IT

  • Name/s of worker involved in the task

  • Upload any relevant photos

  • Signature

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.