Title Page
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Prepared by
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Date
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Location
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Task Number
Initial Questions
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Do I understand the SWMS (If applicable to the task)?
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Do I understand the SOP's / Procedures applicable to task
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Do I have the right tools and PPE for the task
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Have I located existing services?
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Am I fit for work?
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Can I strain or overexert myself?
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Can I fall on, in or from anything?
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Can I be injured by nearby activities, or can my activities injure others nearby?
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Am I or others at risk from the operation of mobile plant or vehicles?
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Can I come into contact with something that can harm me? (e.g. hazard prompts)
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For red answers, hazard controls must be put into place to eliminate / minimise the risk and documented below
Hazard Control
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Hazard 1
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Control
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Implemented?
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Hazard 2
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Control
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Implemented?
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Hazard 3
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Control
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Implemented?
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Hazard 4
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Control
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Implemented?
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Hazard 5
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Control
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Implemented?
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Hazard 6
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Control
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Implemented?
