Take 5

• Name

• Date

  Date
• Location
  Address

• Job Description

HAZARD IDENTIFICATION

Focus on critical risks - Safety Essentials

• 1. Am I working with electricity?

  Yes

  No

• 2. Is there a risk I could fall more than 2m?

  Yes

  No

• 3. Is there a risk I could become fatigued whilst driving?

  Yes

  No

• 4. Am I working in the vicinity of utility services?

  Yes

  No

• 5. Am I completing excavation works or working in excavations or trenches deeper than 1.5m?

  Yes

  No

• 6. Am I working in the vicinity of vehicular traffic?

  Yes

  No

• 7. Am I working in and around mobile plant?

  Yes

  No

• 8. Am I working in a remote or isolated location?

  Yes

  No

• 9. Am I performing heavy lifting using a crane or plant?

  Yes

  No

• 10. Could I be exposed to asbestos?

  Yes

  No

• 11. Am I working in a confined space?

  Yes

  No

• If you answered Yes to any of the above questions, you must have a completed and approved SHEWMS relevant to the activity. Note SHEWMS reference number below.

• Are there any other hazards? (identify hazards not covered in the SHEWMS or if you answered No to all questions above and are not using a SHEWMS)

  Yes

  No

• Enter hazard

Hazard

• Hazard Description

• Risk Rating?

  Extreme

  Very High

  High

  Moderate

  Low

• 

• Applicable SWI / EI

• Risk Controls

ASSESS AND MANAGE THE RISKS

• Assess the overall risk of the task being performed with the controls in place as noted above or in the SHEWMS to check whether they are effective at eliminating or minimising risk to an acceptable level

• Overall Risk Rating?

  Extreme

  Very High

  High

  Moderate

  Low

• 

• Is the risk at an acceptable level?

  Yes

  No

• If No, contact your Supervisor to discuss alternative control measures. Reassess risk and control measures if planned work processes or work conditions change.