Title Page
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Conducted on
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Prepared by
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Location
General
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Task description
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Take photo of work environment
Before Task Commences
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Do I clearly understand what is required?
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Am I trained to do the work and familiar with the equipment/task?
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Are the tools and equipment in a safe condition?
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Do I have approved documentation for the task?
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Am I safe from other activities/tasks in the area?
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Have I informed others who may be affected by my work?
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Do I have the correct PPE for the Task?
Hazards
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Have I identified any hazards associated with the task?
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Description of hazards
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Take photo of hazards
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Description of controls
Risk Assessment
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Have all hazard controls been implemented?
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Have all potential problems been discussed and understood by all?
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Can the Task proceed safely?
Completion
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Other observations comments
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Sign off