Title Page

  • Document No.

  • Job Location

  • Job Description

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Take 5

STOP - Do I fully understand the task

  • Am I competent and authorised?

  • Discuss task with your supervisor before proceeding.

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  • Have any task changes been considered?

  • Discuss task with your supervisor before proceeding.

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  • Do I have the correct PPE, tools, pre start and equipment?

  • Discuss task with your supervisor before proceeding.

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  • Do I require a permit for the job?

  • Discuss task with your supervisor before proceeding.

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THINK - What are the hazards?

  • Can I be caught in, on or between anything?

  • Can I manage the hazards?

  • Discuss the task with your supervisor before proceeding

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  • Can something fall on or strike me?

  • Can I manage the hazards?

  • Discuss the task with your supervisor before proceeding

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  • Can I strain or over except myself?

  • Can I manage the hazards?

  • Discuss the task with your supervisor before proceeding

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  • Is any equipment in the task required to be positively isolated?

  • Can I manage the hazards?

  • Discuss the task with your supervisor before proceeding

    Stop.png
  • Are there any hidden hazards that may harm me - chemicals, gases, fumes, heat, electricity, stored energy, poor communications or ventilation?

  • Can I manage the hazards?

  • Discuss the task with your supervisor before proceeding

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  • Can I slip, trip or fall?

  • Can I manage the hazards?

  • Discuss the task with your supervisor before proceeding

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  • Is access or egress a problem?

  • Can I manage the hazards?

  • Discuss the task with your supervisor before proceeding

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  • Is additional lighting required?

  • Can I manage the hazards?

  • Discuss the task with your supervisor before proceeding

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  • Could there be an uncontrolled movement?

  • Can I manage the hazards?

  • Discuss the task with your supervisor before proceeding

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  • Can this task affect the safety of my workmates or harm the environment?

  • Can I manage the hazards?

  • Discuss the task with your supervisor before proceeding

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  • Do I need to barricade the work area?

  • Can I manage the hazards?

  • Discuss the task with your supervisor before proceeding

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  • Do I know where the nearest escape route, refuge chamber or muster point is?

  • Can I manage the hazards?

  • Discuss the task with your supervisor before proceeding

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  • I am safe to proceed with the task

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.