TAKE 5
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Site conducted
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Conducted on
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Prepared by
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Location
TAKE 5
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TASK
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1. THINK THROUGH THE TASK
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Do you understand the task scope?
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Does a procedure exist?
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Do you understand the steps required to do the task?
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Are tools and equipment in good order?
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Do you have the correct PPE?
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Do you have the necessary permits?
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Have you got a clear plan in mind?
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2. SPOT THE HAZARDS (see step 2 on inside front cover)
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Will | be operating equipment with the guards removed?
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Am I or others at risk from the operation of vehicles or mobile equipment?
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Does the task involve hazardous materials?
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Will I be performing a task without a specific isolation procedure?
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Will I be working at heights?
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Will I be impacted by other activity in the vicinity?
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Other environmental and/or H&S hazards? (List over page)
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3. ASSESS THE RISKS (from risk table on back cover)
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Is the risk level equal to or greater than H11 If YES complete a JHA (otherwise list all hazards, risk scores and all controls over page)
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4. MAKE THE CHANGES
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Implement controls and review Take 5 if changes in the task occur
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5. DO THE TASK SAFELY
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DOC# 0125574 3/16
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HAZARDS
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CONTROLS
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RISK SCORE
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Signature:
