Take 5 Risk Assessment Checklist

• Conducted on

  Date

• Prepared by

• Location
  Address

General

• Task description

• Take photo of work environment

  Media

Before Task Commences

• 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

• Am I safe from other activities/tasks in the area?

  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 for the Task?

  Yes

  No

  N/A

Hazards

• Have I identified any hazards associated with the task?

  No

  Yes

• Description of hazards

• Take photo of hazards

  Media

• Description of controls

Risk Assessment

• Have all hazard controls been implemented?

  Yes

  No

  N/A

• Have all potential problems been discussed and understood by all?

  Yes

  No

  N/A

• Can the Task proceed safely?

  Yes

  No

  N/A

Completion

• Other observations comments

• Sign off

  Sign