Title Page

  • Task

  • Location
  • Conducted by

  • Conducted on

Stop and Think Through the Task

  • Do I clearly understand what is required?

  • Am I trained to do the work and familiar with the equipment/task?

  • Are the tools and equipment in a safe condition?

  • Do I have approved documentation for the task?

  • Have I informed others who may be affected by my work?

  • Do I have the correct PPE/RPE for the task (identified in the risk assessment/method statement)?

Identify and Assess the Hazards

  • Provide corrective actions for hazards identified by clicking on 'Action' on the items below. Describe the action to take, assign a member, set priority level and due date.

  • Hazard
  • Hazard type

  • Please specify hazard type

  • Take or attach photo evidence of hazard identified

  • Describe the hazard

  • Refer to image below for risk level

    risklevel.PNG
  • Priority for action

  • Refer to image below for likelihood

    consequence.PNG
  • Likelihood

  • Control measure

Control and Monitor

  • Are all hazards identified controlled or removed?

Completion

  • Name & Signature of Assigned Employee

  • Name & Signature of Supervisor

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