Information
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Document No.
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Client
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Job Number
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Task Description
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Conducted on
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Location
THINK About The Task
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Do you understand the task?
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Do you understand the Procedure?
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Do you have the correct tools?
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Are they in good condition
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Do you have the correct PPE?
IDENTIFY The Hazards
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Manual Handling, Slips, Trips, Falls?
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Mechanical, Moving Parts, Etc?
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Are there any Energy Sources
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Electricity
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Water
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Hydraulic
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Gas
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Chemical
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Steam
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Surroundings (Overhead, Noise, Heat, Cold)?
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Chemicals, Biological, Radiation?
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Any other Hazards?
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Type Here
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Draw Here
ASSESS The Risk
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Risk Matrix
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Risk Result.
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DO NOT PROCEED, COMPLETE A FULL JSEA.
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Review Controls and ensure they are accurate.
MANAGE The Changes
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Hazards eliminated or controlled?
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Issues discussed with Manager
PROCEED With The Task
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Sign Here
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Please Sign before continuing.
