Take 5 Quality Score Card

• Date of Take 5

• Client / Site

• Conducted on

  Date

• Prepared by

ALL SECTIONS COMPLETE

• Please select you’re assessment score from 1 – 5. 1 being “Not all sections completed” to 5 being “All sections completed”

INFORMATION MISSING

• Please select you’re assessment score from 1 – 5. 1 being “Information missing (e.g. name, date)” to 5 being “No information missing”

NO HAZARDS IDENTIFIED

• Please select you’re assessment score from 1 – 5. 1 being “No hazards identified” to 5 being “All applicable hazards identified”

NO CONTROLS IDENTIFIED

• Please select you’re assessment score from 1 – 5. 1 being “No controls identified” to 5 being “All applicable controls identified”

HAZARDS APPROPIATE TO THE TASK

• Please select you’re assessment score from 1 – 5. 1 being “Hazards aren’t appropriate to the task” to 5 being “All hazards are appropriate to the task”

IDENTIFIED CRITICAL HAZARDS

• Please select you’re assessment score from 1 – 5. 1 being “Failed to identify critical hazards” to 5 being “Identified all critical hazards for the task”

CONTROLS NOT APPROPRIATE FOR THE RISK

• Please select you’re assessment score from 1 – 5. 1 being “Controls aren’t appropriate for the risk” to 5 being “Controls adequately reduce the risk”

RISK SCORE NOT COMPLETED

• Please select you’re assessment score from 1 – 5. 1 being “Risk score not completed” to 5 being “Risk scores completed properly e.g. “L4”

RISK SCORE DOES NOT CHANGE FOR DIFFERENT HAZARDS

• Please select you’re assessment score from 1 – 5. 1 being “Risk score does not change for different hazards” to 5 being “Risk scores fluctuate appropriately according to the controls in place”

PERSONNEL UNDERSTANDS TBRA

• Please select you’re assessment score from 1 – 5. 1 being “DOES NOT UNDERSTAND AND REQUIRES TRAINING' 5 being “UNDERSTANDS WELL NO TRAINING REQUIRED'