Take 5 Risk Assessment Checklist - duplicate

• Job Number

• Job Title

• Location of site
  Address

• Conducted on

  Date

• Prepared by

• Staff Included in Assessment

  Select

General - Before Leaving Office (for each new site visit)

• Is there a signed LOE that includes todays field work in the scope?You will need to click "repeat visit" below and complete the daily checklist...

  Yes

  No

• You shouldn't be doing work without an LOE or outside the scope of an LOE. Director approval is required before proceding.

• Who Approved this?

  Select

• Is this a repeat visit for a previously assessed activity (note the activity you are conducting must have previously been assessed in the Safety Analysis Section below and all people involved should have signed the assessment).

  Yes

  No

• You will need to complete a safety analysis - All people involved in project should be involved (click +).

Safety Analysis

• Identify relevant SWMS for tasks that will be completed on site (Safe Work Method Statements) (multi-select)

  Select

• Describe activity that is Covered by a SWMS

• Is there any Work NOT covered by a SWMS

  Yes

  No

• If YES you MUST complete a JSA (Job Safety Analysis) (separate form) and summarise below.

• Enter brief summary of JSA

• What is the worst Risk identified in the JSA PRIOR to mitigation

  Low

  Med

  High

  Extreme

• You MUST have a director approved risk management plan

• Confirm there is a mitigation plan

  Yes

  No

• DO NOT PROCEED - HIGH or EXTREME residual risks are NOT acceptable without Director Signoff, even with director signoff the risk should be reduced to Low or Medium unless it is not practical. If risk cannot be reduced consider alternatives or engage specialist support. Director is to consider all of this before approving.

• Confirm that ALL people involved agree the mitigation is expected to achieve required reduction in risk to Low or Medium

  Yes

  No

• DO NOT PROCEED - HIGH or EXTREME residual risks are NOT acceptable without Director Signoff, even with director signoff the risk should be reduced to Low or Medium unless it is not practical. If risk cannot be reduced consider alternatives or engage specialist support. Director is to consider all of this before approving.

• Which Director Signed the JSA off?

  Select

• Directors Signature

  Sign

• Identify Tools/Equipment being utilised (click + for each item)

New Item

• Select tools

  Select

• Describe all not on list

• All Staff are trained to do the work and familiar with the equipment/task?

  No

  Yes

  Under Someones Guidance

• Who is under guidance/Training?

• Select Staff members (multi select)

  Select

• Untrained Staff must not undertake work without supervision. Ensure a trained staff member is present.

Pre Departure Hazards identification

• How long is the drive to site

• What is the distance (each way) to site

• Can you share driving?

  Yes

  No

• Identify your stop rest points, minimum 1 stop per 150km or 2 hours driving (whichever is more frequent)

• Are you confident that you (and all people you are sharing driving with) can drive this duration distance safely

  Yes

  No

• Will the total duration of time on duty from departure from office, including all time working on site and the return drive home exceed 9 hours?

  Yes

  No

• Which Director has approved this?

  Select

• Are there any driving associated risks that could create an increased risk

  Select Not a confident driver Not confident in the available vehicle Poor nights sleep in past few nights Jetlag or other long distance travel recently Sport or Recreation Health issues or sickness Medication Drugs or Alcohol Second Job Stress Personal or Family issues Unusual routines Other

  • Not a confident driver
  • Not confident in the available vehicle
  • Poor nights sleep in past few nights
  • Jetlag or other long distance travel recently
  • Sport or Recreation
  • Health issues or sickness
  • Medication
  • Drugs or Alcohol
  • Second Job
  • Stress
  • Personal or Family issues
  • Unusual routines
  • Other

• Please talk to a director - your safety is paramount - has a director approved this?

  Select

• What weather and environmental conditions could affect this task - Select all that may apply (ctrl click to select multiple)

  Select

• Enter Details

• What is the MINimum likely temperature

• Is it appropriate and safe to complete this work in these conditons?

  Yes

  No

• What is the MAXimum likely temperature

• Is it appropriate and safe to do this work in these conditions?

  Yes

  No

• Environmental hazard Summary - Use the chart to determine the leven of Environmental Risk

• Select Environmental Hazard Level

  Low

  Med

  High

  Extreme

• Pause - You should only undertake site work if there is a mitigation plan to reudce risk...

• Are there any measures that can be put in place to manage these environmental Hazards?

  Yes

  No

• Describe mitigation measures (A Director Must sign off the mitigation measures)

• Which director approved the measures and reisudual Risk

  Select

• Signed

  Sign

• Confirm the Residual risk if effective controls are in place

  Yes

  No

• DO NOT PROCEED TO SITE!

• You Should not be proceding to site!

• All STaff Members Invovled are to Sign Off on this assessment:

Staff Member

• Staff Signoff (click + for each staff member)

  Yes

  No

• Select staff member signing

  Select

• Sign here

  Sign

• Name any non BLG people present (eg Clients, Council, other Consultants - Excludes Construction Contractors inducted to site)

Non Staff Personell

• Enter Name

• This person must confirm by signing that they have reviewed the safety analysis above

• Non BLG people must sign.

  Sign

• Is everyone safe from other activities/tasks in the area?

  Yes

  No

Hazard Risk Assessment and reduction

• What Type of Visit is this?

  Select

• Click "Site Hazard Identification" below to complete an Assessment Revision.
  It pays to assess all tasks likely to be executed in the next month to avoid repeat full assessments.
  You will need to complete a new Assessment at least once a month.

SITE Hazard identification

• Click + below to add hazards to site... (complete for each unique hazard)

Site Hazard

• What is the Hazard?

  Select

• Use this Chart to determing Low, Mod, High, Extreme Risk

  

• What is the level of Risk. Use the matrix above to answer...

  Select Low Medium HIGH EXTREME

  • Low
  • Medium
  • HIGH
  • EXTREME

• Use this chart as a guide for likelihood and consequence

  

• You now need to identify how this will be managed using the guide above:

• Select the risk management solution

  Select LOW Risk - Routine Procedures Such as PPE Mod Risk - Routine Procedures PLUS discuss with supervisore before commencing HIGH Risk - Routine Procedures PLUS Additional Case specific actions PLUS Do not proceed until Director Approval Received EXTREME Risk - NO NOT COMPLETE ACTIVITY - Discuss with Director

  • LOW Risk - Routine Procedures Such as PPE
  • Mod Risk - Routine Procedures PLUS discuss with supervisore before commencing
  • HIGH Risk - Routine Procedures PLUS Additional Case specific actions PLUS Do not proceed until Director Approval Received
  • EXTREME Risk - NO NOT COMPLETE ACTIVITY - Discuss with Director

• Describe additional Measures

• Confirm which Director has approved proceding with a HIGH risk (The directors will be notified)

  Select

• ABSOLUTELY NO WAY - DO NOT GO TO SITE - EVEN IF YOU CHANGE YOUR ANSWER NOW - PLEASE TALK TO A DIRECTOR ANYWAY

• Is the Risk of any Site hazards High Or Extreme (Prior to mitigation) - refer to Hazard Identification process above

  Yes

  No

• Description of hazards

• Take photos of hazards

  Media

• Description of controls (list all and describe)

• Take photos of controls in place

  Media

• Complete final Hazard Risk Assessment and Reduction Review below and you are good to go.../

• Have all hazard controls been implemented?

  Yes

  No

• YOU SHOULD NOT BE ON SITE - RESOLVE THIS ISSUE BY REASESSING ABOVE, IF NOT RESOLVED LEAVE SITE

• Have all potential hazards been identified, discussed and understood by all?

  Yes

  No

• Go back and change todays site visit type to something other than "Routine repeat (no new risks)" - this will allow you to complete an appropriate risk assessment.

• Can the Task proceed safely?

  Yes

  No

• DO NOT PROCEED WITH SITE, REPEAT ABOVE ASSESSMENTS, IF SAFETY IS NOT ASSURED THEN LEAVE THE SITE

• All Staff On Site to Sign off

On Site Check Completion

• Take photo(s) of work environment

  Media

• Other observations/comments

• Staff Member Sign off

Staff Member

• Select Staff member

  Select

• Sign Here:

  Sign

• Site Lead Sign off

  Sign

Back In Office Completion

• Did any risks emerge that had not been identified, assessed and mitigated

  Yes

  No

• Has this been followed up by clicking "action" below?

  Yes

  No

• Were there any Incidents or near misses?

  Yes

  No

• You MUST filll out a incident form. (NO EXCEPTIONS)

• You MUST ALSO create an "action" below

• Click Complete, save a PDF to Synergy in the H&S folder for this job

• Site visit lead signoff

  Sign

• Yes

  No