Information

  • Date

  • Completed by:

  • Signature:

  • Task:

  • Location:

  • Document No.

CHECKS

  • 1 - Are relevant people aware of where I'm working?

  • "STOP" and reassess the task. Ensure adequate controls are in place

  • 2 - Is the work area tidy and free of slip/trip hazards?

  • "STOP" and reassess the task. Ensure adequate controls are in place

  • 3 - Do I know about any chemicals involved in this task?

  • "STOP" and reassess the task. Ensure adequate controls are in place.

  • 4 - Has the weather conditions, work environment or poor lighting that could effect job safety been assessed?

  • "STOP" and reassess the task. Ensure adequate controls are in place.

  • 5 - Do I have the right tools and equipment?

  • "STOP" and reassess the task. Ensure adequate controls are in place

  • 6 - Have hot/cold/sharp/heavy or leaking risks been controlled?

  • "STOP" and reassess the task. Ensure adequate controls are in place

  • 7 - Has the equipment been isolated and/or locked off where required?

  • "STOP" and reassess the task. Ensure adequate controls are in place

  • Enter Controls:

  • 8 - Are strains/sprains/ manual handling hazards controlled?

  • "STOP" and reassess the task. Ensure adequate controls are in place

  • Enter Controls:

  • 9 - Am I wearing the right PPE?

  • "STOP" and reassess the task. Ensure adequate controls are in place

  • Enter Controls:

  • 10 - Am I prepared for an emergency?

  • "STOP" and reassess the task. Ensure adequate controls are in place

  • Enter Controls:

CRITICAL ITEMS

  • 11 - Are chemicals/stored energy risks controlled?

  • "STOP"" a JSEA, SWP or relevant permit is required . "Contact your supervisor for assistance".

  • Enter Controls:

  • 12 - Are entanglement/crushing/striking risks controlled?

  • "STOP"" a JSEA, SWP or relevant permit is required . "Contact your supervisor for assistance".

  • Enter Controls:

  • 13 - Am I safe from falling or causing something to fall?

  • "STOP"" a JSEA, SWP or relevant permit is required . "Contact your supervisor for assistance".

  • Enter Controls:

  • 14 - If the tasks you are about to perform is listed as High Risk, have you completed a JSEA or the relevant or trained in the relevant SWP?

  • "STOP"" a JSEA, SWP or relevant permit is required . "Contact your supervisor for assistance".

  • Enter Controls:

If task is reoccurring it must be risk ranked and added to JSEA register.

  • Required actions if response = NO

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.