TAKE 5 - v1

• Please stamp the "Take 5" start time

  Date
• Location
  Address

• Enter your First & Last Name

• Enter Initials of persons with you or "NA" if single person crew.

PRE SITE CHECK

• Check you have these before you enter site - No entry allowed if any items missing

  Select Safety Footwear - AS / NZ 2210 Hi Vis Vest/Clothing Carrying CIS ID and White Card

  • Safety Footwear - AS / NZ 2210
  • Hi Vis Vest/Clothing
  • Carrying CIS ID and White Card

• Is your vehicle parked in a way that it does not obstruct traffic flow and is in accordance with CIS International Traffic Management Plan

  Yes

  No

  N/A

• Have you checked the weather? Please ensure you have the adequate PPE and understand what measures to take to work to the weather conditions? I.e. If raining, ensure you take care not to slip and wipe shoes thoroughly before moving inside.

  Yes

  No

• Please nominate a safe emergency meeting place for today's work and ensure all persons working with you know where this is located. When this is done, select 'Yes' and continue.

  Yes

  No

• When setting up your work zone, particularly around a Pit or Manhole - Please ensure you adhere to CIS Pedestrian and Traffic Management Handbook and confirm you understand to always ensure the safety of yourself and public around you when working. Please confirm you understand this.

  Yes

  No

HAZARDS

• Are you aware of the SWMS, the identified hazards, the associated risks and can perform the methods to reduce the risks?

  Yes

  No

• Do not start work. You may be unsafe to work and could put yourself and colleagues at risk. Please call head office asap to discuss situation and how to progress.

• Are you aware of the SWMS, the identified hazards, the associated risks and can perform the methods to reduce the risks?

  Yes

  No

• Do not start work. You may be unsafe to work and could put yourself and colleagues at risk. Please call head office asap to discuss situation and how to progress.

• Using your SWMS as your guide - Do you all have the adequate PPE to perform the required work safely today?

  Yes

  No

• Do not start work. You may be unsafe to work and could put yourself and colleagues at risk. Please call head office asap to discuss situation and how to progress.

• Are there any hazards you have identified that are not covered in the SWMS? We need your input to ensure the safe work for everybody.

  Yes

  No

• Please enter the nature of hazard and include a photo if you can. It may not be safe to continue work. If you identify hazards that could cause injury or harm, stop work and please call head office to discuss.

• If you are using a ladder at this site, can you confirm you will not access over 2 meters height and you have received Ladder Safety Training?

  Yes

  No - Training not received or accessing over 2 meters

  N/A

• Do not start work. You may be unsafe to work and could put yourself and colleagues at risk. Please call head office asap to discuss situation and how to progress.

• Do you expect to perform any of the following work activities at this site - Enter Manholes, Enter SWL (Special Work Locations)

  Yes - 0

  No - 0

• Can you confirm you have the correct PPE, Guards, Training, Gas Detector and Safety Equipment to perform the task. - Please note is accessing SWL you must have Manhole Recovery Equipment.

  Yes - 0

  No - 0

• Have a great day at work.