STOP TAKE-5

• Conducted on

  Date
• Location
  Address

• Task or WO#

1.0 THINK THROUGH THE TASK

• 

• Work scope and methods understood?

  Yes

  No

  N/A

• Approved work procedures in use? (e.g. SOP/JSA)

  Yes

  No

  N/A

• Permit(s) required have been completed? (Specific hazardous works permit(s) and/or permit to work)

  Yes

  No

  N/A

• Correct PPE available and in good condition?

  Yes

  No

  N/A

• Equipment / plant in good working order and fit for purpose?

  Yes

  No

  N/A

2.0 SPOT THE HAZARD

• 

• Hazards observed or removed? Give details:

3.0 ASSESS THE RISKS

• 

• 

• What is the Raw Risk Score?

  Select L1 Rare / Neg L2 Rare / Min L2 Unlikely / Neg L3 Rare / Mod L3 Possible / Neg L4 Rare / Maj L4 Likely / Neg M5 Rare / Extr M5 Almost cert / Neg M6 Unlikely / Mod M6 Possible / Min M8 Unlikely / Maj M8 Likely / Min M9 Possible / Mod H10 Unlikely / Extr H10 Almost cert / Min H12 Possible / Maj H12 Likely / Mod H15 Possible / Extr H15 Almost cert / Mod E16 Likely / Maj E20 Likely / Extr E20 Almost cert / Maj E25 Almost cert / Extr

  • L1 Rare / Neg
  • L2 Rare / Min
  • L2 Unlikely / Neg
  • L3 Rare / Mod
  • L3 Possible / Neg
  • L4 Rare / Maj
  • L4 Likely / Neg
  • M5 Rare / Extr
  • M5 Almost cert / Neg
  • M6 Unlikely / Mod
  • M6 Possible / Min
  • M8 Unlikely / Maj
  • M8 Likely / Min
  • M9 Possible / Mod
  • H10 Unlikely / Extr
  • H10 Almost cert / Min
  • H12 Possible / Maj
  • H12 Likely / Mod
  • H15 Possible / Extr
  • H15 Almost cert / Mod
  • E16 Likely / Maj
  • E20 Likely / Extr
  • E20 Almost cert / Maj
  • E25 Almost cert / Extr

4.0 MAKE THE CHANGES

• 

• Hazards removed or controlled?

  Yes

  No

  N/A

• Potential problem discussed?

  Yes

  No

  N/A

5.0 DO THE JOB SAFELY (Safety First. We accept nothing less.)

• 

• What is the Residual Risk Score?

  Select L1 Rare / Neg L2 Rare / Min L2 Unlikely / Neg L3 Rare / Mod L3 Possible / Neg L4 Rare / Maj L4 Likely / Neg M5 Rare / Extr M5 Almost cert / Neg M6 Unlikely / Mod M6 Possible / Min M8 Unlikely / Maj M8 Likely / Min M9 Possible / Mod H10 Unlikely / Extr H10 Almost cert / Min H12 Possible / Maj H12 Likely / Mod H15 Possible / Extr H15 Almost cert / Mod E16 Likely / Maj E20 Likely / Extr E20 Almost cert / Maj E25 Almost cert / Extr

  • L1 Rare / Neg
  • L2 Rare / Min
  • L2 Unlikely / Neg
  • L3 Rare / Mod
  • L3 Possible / Neg
  • L4 Rare / Maj
  • L4 Likely / Neg
  • M5 Rare / Extr
  • M5 Almost cert / Neg
  • M6 Unlikely / Mod
  • M6 Possible / Min
  • M8 Unlikely / Maj
  • M8 Likely / Min
  • M9 Possible / Mod
  • H10 Unlikely / Extr
  • H10 Almost cert / Min
  • H12 Possible / Maj
  • H12 Likely / Mod
  • H15 Possible / Extr
  • H15 Almost cert / Mod
  • E16 Likely / Maj
  • E20 Likely / Extr
  • E20 Almost cert / Maj
  • E25 Almost cert / Extr

• Can this job continue safely?

  Yes

  No

  N/A

• NOTES: