Take 5 Pre-task Risk Assessment

• Task

• Location
  Address

• Conducted by

• Conducted on

  Date

Stop and Think Through the Task

• Do I clearly understand what is required?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are the tools and equipment in a safe condition?

  Yes

  No

  N/A

• Do I have approved documentation for the task?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Identify and Assess the Hazards

• Provide corrective or mitigation actions for hazards identified. Describe the action to take and assign a member.

Look for Hazards

• Gravitational (slips, unstable trees, falling risk...)

  Yes

  No

• Site management (Plant onsite, traffic management)

  Yes

  No

• Electrical (electrocution, faulty wiring, underground services)

  Yes

  No

• Manual Handling (lifting, DCPs, HA, twisting...)

  Yes

  No

• Biological (bacteria, animals, contaminated soil & water...)

  Yes

  No

• Confined spaces (if yes, do not enter)

  Yes

  No

• Describe the hazard

• Refer to image below for risk level

  

• Priority for action

  Extreme Risk

  High Risk

  Medium

  Low Risk

• Refer to image below for likelihood

  

• Likelihood

  Almost Certain

  Likely

  Possible

  Unlikely

  Rare

• Control measure

Control and Monitor

• Are all hazards identified controlled or removed?

  Yes

  No

Completion

• Name & Signature of Assigned Employee

• Name & Signature of Supervisor