Title Page
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Conducted on
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Prepared by
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Location
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Client / customer
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Task description
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Team members
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Have you spoken to the site owner / manager for work direction and hazards?
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Do you know site health & safety rules?
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Have you made all attempts to find this information?
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Do you think it is safe to proceed?
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Call line manager and await direction.
STOP, step back and look
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After reading the Job Sheet do all team members understand what needs to be done?
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Clarify tasks with line manager or project officer
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Do I have the correct PPE and is it in good condition for the task?
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Have you sourced correct PPE?
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Call line manager and await direction.
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Do I have the suitable tools and equipment for the task?
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Acquire suitable tools / equipment.
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Call line manager and await direction.
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Am I trained, competent, licensed and fit to perform the task, or working under the direct supervision of someone who is?
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IT IS NOT SAFE TO PROCEED, stop work and discuss with your supervisor.
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Do I have access to appropriate emergency and first aid equipment?
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Do you consider it is safe to proceed?
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Call line manager and await direction.
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Ensure there is safe way of getting in and out of your work area and all team members know it?
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Everyone is aware of emergency muster area?
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Designate an emergency muster area and inform all team members.
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Is there appropriate separation of vehicles and the general public from the proposed work site?
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Rearrange work site / signs / lights to ensure suitable separation from public.
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Is all required electrical/mechanical equipment in a safe condition?
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If it can't be fixed quickly, replace it, lock it out and call line manager.
THINK - identify the hazards
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Are any of the following hazards present?
- Chemical (e.g. handling, inhaling, touching substances)
- Dust and Fume (e.g. welding fume, asbestos dust/fibre)
- Electrical
- Slips, trips and falls, or struck by falling objects
- Manual Handling (e.g. lifting awkward positions, over-exertion, is additional help required)
- Mechanical (e.g. caught in moving parts, struck by plant or flying objects)
- Noise (e.g. hearing damage)
- Pressure (e.g. contact with pressurised fluid, gas, air)
- Traffic Management
- Dangerous animals
- Working around open water
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Other hazards present, including site specific hazards?
PLAN - assess the level of risk
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Have you assessed the risk for each hazard identified?
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Refer to JSEAs for to identify medium to high risk hazards
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If you are still unsure ask for assistance from line manager.
ACT - control the hazards
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Are hazards effectively controlled?
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Refer to JSEAs for to identify controls for hazards
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IT IS NOT SAFE TO PROCEED, stop work and discuss with your supervisor
REVIEW - proceed safely and review
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Is it safe to proceed?
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IT IS NOT SAFE TO PROCEED, stop work and discuss with your supervisor
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Have you consulted with workers about the task and hazards and the safe way to do work?
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Go through this form with them from STOP - step back and look
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Sign off
Photo record for project officers
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Take site photo (before)
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Take site photo (during)
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Take site photo (after)
