Stop, Look, Assess, Manage

• Task

• Client

• Job Location
  Address

• Work Order No:

• Date

  Date

• Employee Name

1. STOP! Think through the Task

• Do you have a clear understanding of the job required?

  Yes

  No

  N/A

• You need to have a clear understand of the job required before continuing

  

• Do you have the required permits to complete the task? e.g B.A.S. WAAP, Mackay Base Hospital WAP?

  Yes

  No

  N/A

• You need the required permits

  

• Do you have the correct PPE as required by CVPG – e.g, safety glasses, hi-vis vest, steel-cap boots?

  Yes

  No

  N/A

• You need the correct PPE

  

• Are all your tools/equipment in good order for work to be undertaken?

  Yes

  No

  N/A

• You need the correct PPE

  

• Are you able to complete the task with the resources you have on hand? (materials, manpower)

  Yes

  No

  N/A

• You need the correct PPE

  

2. LOOK! Spot the Hazard

• Is there any possibility that asbestos could be contained within your job area?

  Yes

  No

  N/A

• STOP WORK IMMEDIATELY AND SEEK FURTHER INSTRUCTION FROM YOUR SUPERVISOR

  

• Does the scope of work involve you to work; above 2m, in excavations deeper than 1.5m, with live electrical<br>components, with hazardous substances/materials, on/adjacent to a road, in a confined space or with powered<br>mobile plant?

  Yes

  No

  N/A

• STOP WORK IMMEDIATELY AND SEEK FURTHER INSTRUCTION FROM YOUR SUPERVISOR > You will require a Safe Work Method Statement

  

• Are there any associated risks to yourself or others from machinery, mobile equipment, vehicular hazards or from any of the examples below?

  Select Air pollution (dust, fumes) Noise pollution Hazards to flora/fauna Spills to ground/waterways Contact with electricity High pressure air/water/gas Safe access/egress Fire explosion Manual handling Impact from/on other worker Power tools Caught in between objects Struck by objects Over exertion/repetitive tasks Other

  • Air pollution (dust, fumes)
  • Noise pollution
  • Hazards to flora/fauna
  • Spills to ground/waterways
  • Contact with electricity
  • High pressure air/water/gas
  • Safe access/egress
  • Fire explosion
  • Manual handling
  • Impact from/on other worker
  • Power tools
  • Caught in between objects
  • Struck by objects
  • Over exertion/repetitive tasks
  • Other

3. ASSESS the Risk

• Have you answered Yes to Parts A or B in Section 2 above?

  Yes

  No

  N/A

• CONSULT WITH YOUR SUPERVISOR IMMEDIATELY TO OBTAIN FURTHER INSTRUCTION

• Have you answered Yes to Parts C or D in Section 2 above?

  Yes

  No

  N/A

• CONSULT WITH YOUR SUPERVISOR AND REFER TO SAFE WORK PROCEDURES PROVIDED TO YOU IN TOOLBOX TALK TRAINING KEPT IN UTE

4. MANAGE – Make the Changes

• Implement controls and review this hazard form if changes to the task occur

  Done

  Will do later

• Employee signature

  Sign