Take 5

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

STOP and THINK THROUGH THE TASK / ASK YOURSELF

• 1. Am I trained competent and authorised to do the task or enter the work area? Check with your supervisor if you are unsure

  Yes

  No

  N/A

• Identify hazards / what could be fatal or harm me / others?

• What controls will protect me / others?

• 2. Am I in a fit condition to complete the task? Seek support if you require assistance for fatigue, physical or mental well-being

  Yes

  No

  N/A

• Identify hazards / what could be fatal or harm me / others?

• What controls will protect me / others?

• 3. Do I require permits / JSA to conduct this task and if so, have I reviewed and signed off on them?

  Yes

  No

  N/A

• Identify hazards / what could be fatal or harm me / others?

• What controls will protect me / others?

• 4. If a procedure or work instruction exists for the task, am I familiar with it? Speak up and refresh yourself on task instructions if required

  Yes

  No

  N/A

• Identify hazards / what could be fatal or harm me / others?

• What controls will protect me / others?

• 5. Do I have fit for purpose tools, equipment and PPE?

  Yes

  No

  N/A

• Identify hazards / what could be fatal or harm me / others?

• What controls will protect me / others?

• 6. Do I require positive communication to ensure that others are aware of my presence and intentions? Ensure positive verbal/radio communications are made before commencing the task if required

  Yes

  No

  N/A

• Identify hazards / what could be fatal or harm me / others

• What controls will protect me / others