Take 5

• I am conducting the following check

  Take 5

• Name of person conducting

• Date

  Date
• Location
  Address

1. Step 1 STOP and THINK through the task

• Brief explanation of the task.

• Work/Job Number

• a. Is the task a mandatory Permit to Work (PTW)Task ?

  Yes

  No

• A PTW is required for any work activity at a Goodman Fielder workplace that involves:
  Confined space entry/work
  Hot Work
  Working at heights, where there is an uncontrolled risk of injury from falling.
  High Voltage isolation
  Any ground penetration/excavation.
  Work on energised equipment (Note this does not include testing).
  Work on running equipment without a guard.
  Fire system isolation.
  Asbestos.
  Penetration (i.e. structural penetrations that could create risk by contact with hidden services e.g.electricity/gas/high pressure)
  Critical Lifts.
  Demolition.
  Other Work based on risk assessment (e.g.JSEA), GF/the permit issuer may determine a task requires a permit.

• b. Do you understand what you need to do ?

  Yes

  No

• c. Are you trained, competent, licensed and fit to perform the task ?

  Yes

  No

• d. Do you have suitable tools and equipment to perform the task safely ?

  Yes

  No

• e. Do you have the correct PPE, in good condition, for the task ?

  Yes

  No

• f. Do you have a JSEA/Risk Assessment or SOP for the task ?

  Yes

  No

• If you answered NO to any of the above b-g, stop and discuss with your Supervisor prior to continuing to Step 2.

• g. Will people working in the area remain safe while you undertake the task ?

  Yes

  No

2. Consider the Hazards

• What could cause harm ? If more than 3 hazards are identified, stop and complete JSEA.

• Consider the Hazards:
  Housekeeping
  Slip/Trip/Fall
  Falling Objects
  Lifting/pushing/pulling
  Posture/repetition
  Working with ladders
  Working alone
  Lighting/visibility
  Energy Sources (e.g. gravity)
  Work on live equipment (electrical)
  Powered tools/hand tools
  Mobile plant/equipment/vehicles
  Mechanical/entrapment
  Pinch points/moving parts
  Pressurised fluid/gas/air/chemicals
  Chemical
  Hot surfaces
  Noise/Vibration
  Spill or pollution
  Trade Waste
  Fumes/odour/dust/atmospheric emissions
  Land or groundwater contamination
  Weather - Hot or Cold
  Stress/Fatigue
  Impact to food stream
  Communication difficulties
  Cut potential
  Other (specify)

• List Hazard

• List Hazard

• List Hazard

• List further hazards

• Comments if required

3. Assess Risk

• What is the most credible consequence if the hazard is poorly controlled ? How likely is the event to occur ? What is the uncontrolled risk rating/score for each hazard ?

• Overall Risk Rating? Risk 1

  Extreme

  High

  Medium

  Low

• 

• Overall Risk Rating? Risk 2

  Extreme

  High

  Medium

  Low

• Overall Risk Rating? Risk 3

  Extreme

  High

  Medium

  Low

• What is the highest risk of the three hazards ?

  Extreme

  High

  Medium

  Low

• STOP and complete JSEA

• Continue TAKE 5

4 . Make the Changes

• How will the hazard be eliminated/managed ? Document controls/actions for each hazard. Have you removed the hazards or implemented effective controls?
  If Not , STOP and re-assess.