Take 5

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

NAME

DATE

JOB DESCRIPTION & LOCATION

IF YOU ANSWER "AT RISK" TO ANY QUESTIONS YOU MUST LIST THE CONTROLS UNDERNEATH

• Do you know what you are doing? (Ticketed, qualified etc)

  Safe

  At Risk

  N/A

• Vehicle interaction (including reversing)

  Safe

  At Risk

  N/A

• Ground movements (slumping,cracking etc)

  Safe

  At Risk

  N/A

• Work surfaces (clear & level)

  Safe

  At Risk

  N/A

• Visibility (clear,obscured?)

  Safe

  At Risk

  N/A

• Traffic control & signage

  Safe

  At Risk

  N/A

• Slips,trips,falls

  Safe

  At Risk

  N/A

• Isolation/separation of/from energy sources (Machinery,power source etc)

  Safe

  At Risk

  N/A

• Environmental (possibility of spillage or discharge)

  Safe

  At Risk

  N/A

• Fire/explosion

  Safe

  At Risk

  N/A

• Manual handling

  Safe

  At Risk

  N/A

• Equipment fit for use (tools in good conditions, power cables in good condition etc)

  Safe

  At Risk

  N/A

• Portable RCD in place for electrical work

  Safe

  At Risk

  N/A

• UV Exposure (working outside for prolonged periods of time?)

  Safe

  At Risk

  N/A

• Are you fit for work? (Had enough sleep, hydrated etc)

  Safe

  At Risk

  N/A