Stop and Take 5 V.2

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

**** Report is to be considered an uncontrolled and/or unverified document if there is no original signature next to the electronic versions. ****

Stop, Step Back, Observe

• Has a Risk assessment (JSA) been completed for the site/task?

  Yes

  No

  N/A

• Have you got the correct PPE for the site/task?

  Yes

  No

  N/A

• Have you been inducted to this site?

  Yes

  No

  N/A

• If no, is there one available?

  Yes

  No

  N/A

• Are you going to be escorted?

  Yes

  No

  N/A

• Have you looked close, looked wide and looked above for hazards?

  Yes

  No

  N/A

Walk-Through Tasks

• Is the work area in good order?

  Yes

  No

  N/A

• Is access okay?

  Yes

  No

  N/A

• Are Safe Operating Procedures available for this task?

  Yes

  No

  N/A

• Do you understand the job/task requirements?

  Yes

  No

  N/A

Identify Hazards

• Assess the risk of being struck by vehicles or mobile plant (outside walkways = at risk)

  Safe

  At Risk

  N/A

• Assess the risk of being or becoming isolated from others (> 50m = at risk)

  Safe

  At Risk

  N/A

• Assess the risk of communicating with others if in trouble (language or no reception = at risk)

  Safe

  At Risk

  N/A

• Assess the risk of manual handling activities (over 15kg = at risk)

  Safe

  At Risk

  N/A

• Assess the risk of accessing and working at heights (at heights = at risk)

  Safe

  At Risk

  N/A

• Assess the risk of accessing and working in confined spaces (confined space = at risk)

  Safe

  At Risk

  N/A

• Assess the risk of plant/equipment fail due to poor maintenance, etc (damaged = at risk)

  Safe

  At Risk

  N/A

• Are identified risks covered by the JSA?

  Yes

  No

  N/A

• Have you the means to control these additional hazards?<br>Detail hazards and controls.

  Yes

  No

  N/A

Access and Control Risk

• Is risk assessment available?

  Yes

  No

  N/A

• What is the level of risk?<br>(If high or extreme - perform a full risk assessment)<br>

  Safe

  At Risk

  N/A

• Are Hazard(s) removed or controlled?<br>(Provide details)

  Yes

  No

  N/A

• Have potential problems been discussed/resolved?

  Yes

  No

  N/A

Safely Complete Task

• Can this job/task continue safely?

  Yes

  No

  N/A

Sign off

• Sign off as confirmation of understanding

Person:

• Name, Company, Position & Sign

  Sign