TAKE 5 - Novaproducts

• Prepared by

• Conducted on

  Date
• Location
  Address

TAKE FIVE

• Task / Job Number:

• Location:

• 

1. STOP! THINK THROUGH THE TASK

• Am I clear on what the task is?

  Yes

  No

  N/A

• Do I have the required skills, training, and licenses for the task?

  Yes

  No

  N/A

• Have I checked the JSA/JHA/SWMS/procedures for the task?

  Yes

  No

  N/A

• Is all my equipment and tools correct and in good order?

  Yes

  No

  N/A

• Do I have the necessary permits for the task?

  Yes

  No

  N/A

• Do I have the correct personal protective equipment?

  Yes

  No

  N/A

2. LOOK FOR HAZARDS

• Atmospheric: Weather extremes, high humidity, dust, dangerous gases

  Safe

  At Risk

  N/A

• Biological: Bacteria, viruses, insects, plants, birds, animals

  Safe

  At Risk

  N/A

• Chemical: Acids, bases, solvents, heavy metals, poisons, vapours.

  Safe

  At Risk

  N/A

• Electrical: Electrocution, faulty wiring or equipment, earthing points

  Safe

  At Risk

  N/A

• Environmental: Confined spaces, poor lighting, loud noises, temperatures.

  Safe

  At Risk

  N/A

• Fire/Explosions: Open flames, combustible materials, electrical arching

  Safe

  At Risk

  N/A

• Gravitational: Falls, slips, trips, falling objects.

  Safe

  At Risk

  N/A

• Manual Handling: Lifting, pushing, pulling, twisting, awkward positions

  Safe

  At Risk

  N/A

• Mechanical: Impacts, entanglements, stabbing, crushing, suction

  Safe

  At Risk

  N/A

• Pressure: Air, water, oil, gas, vacuums, high/low pressures.

  Safe

  At Risk

  N/A

3. ASSESS THE HAZARDS

• Is the risk level 6 or above for the identified hazard?

  Yes

  No

  N/A

4. MAKE THE HAZARD SAFE

• Have I removed the hazards and/or implemented effective controls?

  Yes

  No

  N/A

• Can I complete the task safely?

  Yes

  No

  N/A

5. COMPLETE THE TASK SAFELY

• IF NO, STOP! <br>See your supervisor. Further action is required. Please go to the next page and make a Hazard Report

  Yes

  No

  N/A

• Signature

  Sign

HAZARD REPORT

• Location of hazard:

• Hazard type:

• Hazard description:

• Risk rating (see risk assessment matrix):

• Corrective action:

• Has the risk been effectively controlled?:

  Yes

  No

  N/A

• Send photos to support this report

  Media

• Detail any further action required:

• Reported to: