Anonymous

Take 5 Carbon Copy

Take 5

Use this Template

Print as PDF

Use this Template

Title Page

Conducted on
Prepared by

Take 5

Carbon Harm ID Take 5

Task
Work Team
1 Workscope/procedure understood?
2 Have I got the right PPE?
3 Can weather, poor lighting affect the job safety?
4 Need to communicate with anyone about the job?
5 Is there anything or anyone above, below, behind or inside (Abbi) that can cause harm?
6 Do I require a permit or certificate?
7 Area I’m safe condition?
8 Can what we are doing cause harm (ergonomics, trips, pinchpoints etc)?
9 Do I need to isolate and release energy sources?
10 Is there potential for the environment to harm me/us (noise, dust, fume, heat, chemicals etc?
11 If something changes I will stop, go back and reassess
12 Can I control Hazards that cause harm with this take 5?

Anonymous

Take 5 Carbon Copy

Take 5

Use this Template

Print as PDF

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.