Take 5

• Site or Work Area

• Conducted on

  Date

• Type of Work

  Select Civil General Construction High Voltage Electrical Low Voltage Electrical Commissioning Demolition HV Plant Erection HV Plant Removal

  • Civil
  • General Construction
  • High Voltage Electrical
  • Low Voltage Electrical
  • Commissioning
  • Demolition
  • HV Plant Erection
  • HV Plant Removal

Site / Work Area Related Hazards Considered

• Slipping / Tripping Hazard

  Risk

  Safe

  N/A

• Risk:

• Add Photo

  Media

• Likelihood Before:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence Before:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Control Method:

  Select Elimination Substitution Isolation Engineering Controls Administrative Controls PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering Controls
  • Administrative Controls
  • PPE

• Control Method Notes:

• Add Photo

  Media

• Likelihood After:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence After:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Notes

• Workplace Noise

  Risk

  Safe

  N/A

• Risk:

• Add Photo

  Media

• Likelihood Before:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence Before:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Control Method:

  Select Elimination Substitution Isolation Engineering Controls Administrative Controls PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering Controls
  • Administrative Controls
  • PPE

• Control Method Notes:

• Add Photo

  Media

• Likelihood After:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence After:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Notes

• Working Remotely / Working Alone

  Risk

  Safe

  N/A

• Risk:

• Add Photo

  Media

• Likelihood Before:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence Before:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Control Method:

  Select Elimination Substitution Isolation Engineering Controls Administrative Controls PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering Controls
  • Administrative Controls
  • PPE

• Control Method Notes:

• Add Photo

  Media

• Likelihood After:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence After:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Notes

• Emergency Vehicle Access / Emergency Personnel Access

  Risk

  Safe

  N/A

• Risk:

• Add Photo

  Media

• Likelihood Before:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence Before:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Control Method:

  Select Elimination Substitution Isolation Engineering Controls Administrative Controls PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering Controls
  • Administrative Controls
  • PPE

• Control Method Notes:

• Add Photo

  Media

• Likelihood After:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence After:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Notes

• Environmental Impact

  Risk

  Safe

  N/A

• Risk:

• Add Photo

  Media

• Likelihood Before:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence Before:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Control Method:

  Select Elimination Substitution Isolation Engineering Controls Administrative Controls PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering Controls
  • Administrative Controls
  • PPE

• Control Method Notes:

• Add Photo

  Media

• Likelihood After:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence After:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Notes

• Vehicles or Traffic

  Risk

  Safe

  N/A

• Risk:

• Add Photo

  Media

• Likelihood Before:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence Before:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Control Method:

  Select Elimination Substitution Isolation Engineering Controls Administrative Controls PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering Controls
  • Administrative Controls
  • PPE

• Control Method Notes:

• Add Photo

  Media

• Likelihood After:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence After:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Notes

Task Related Hazards

• High Voltage Electrical Hazards

  Risk

  Safe

  N/A

• Risk:

• Add Photo

  Media

• Likelihood Before:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence Before:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Control Method:

  Select Elimination Substitution Isolation Engineering Controls Administrative Controls PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering Controls
  • Administrative Controls
  • PPE

• Control Method Notes:

• Add Photo

  Media

• Likelihood After:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence After:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Notes

• Low Voltage Electrical Hazards

  Risk

  Safe

  N/A

• Risk:

• Add Photo

  Media

• Likelihood Before:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence Before:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Control Method:

  Select Elimination Substitution Isolation Engineering Controls Administrative Controls PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering Controls
  • Administrative Controls
  • PPE

• Control Method Notes:

• Add Photo

  Media

• Likelihood After:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence After:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Notes

• Manual Handling

  Risk

  Safe

  N/A

• Risk:

• Add Photo

  Media

• Likelihood Before:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence Before:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Control Method:

  Select Elimination Substitution Isolation Engineering Controls Administrative Controls PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering Controls
  • Administrative Controls
  • PPE

• Control Method Notes:

• Add Photo

  Media

• Likelihood After:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence After:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Notes

• Working at Heights

  Risk

  Safe

  N/A

• Risk:

• Add Photo

  Media

• Likelihood Before:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence Before:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Control Method:

  Select Elimination Substitution Isolation Engineering Controls Administrative Controls PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering Controls
  • Administrative Controls
  • PPE

• Control Method Notes:

• Add Photo

  Media

• Likelihood After:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence After:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Notes

• Asbestos Fibres / Dust

  Risk

  Safe

  N/A

• Risk:

• Add Photo

  Media

• Likelihood Before:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence Before:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Control Method:

  Select Elimination Substitution Isolation Engineering Controls Administrative Controls PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering Controls
  • Administrative Controls
  • PPE

• Control Method Notes:

• Add Photo

  Media

• Likelihood After:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence After:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Notes

• Machinery (Moving Parts, Mobile Plant)

  Risk

  Safe

  N/A

• Risk:

• Add Photo

  Media

• Likelihood Before:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence Before:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Control Method:

  Select Elimination Substitution Isolation Engineering Controls Administrative Controls PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering Controls
  • Administrative Controls
  • PPE

• Control Method Notes:

• Add Photo

  Media

• Likelihood After:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence After:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Notes

• Uneven Surfaces / Open Excavations

  Risk

  Safe

  N/A

• Risk:

• Add Photo

  Media

• Likelihood Before:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence Before:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Control Method:

  Select Elimination Substitution Isolation Engineering Controls Administrative Controls PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering Controls
  • Administrative Controls
  • PPE

• Control Method Notes:

• Add Photo

  Media

• Likelihood After:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence After:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Notes

• Hazardous Substances

  Risk

  Safe

  N/A

• Risk:

• Add Photo

  Media

• Likelihood Before:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence Before:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Control Method:

  Select Elimination Substitution Isolation Engineering Controls Administrative Controls PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering Controls
  • Administrative Controls
  • PPE

• Control Method Notes:

• Add Photo

  Media

• Likelihood After:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence After:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Notes

• Underground Services

  Risk

  Safe

  N/A

• Risk:

• Add Photo

  Media

• Likelihood Before:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence Before:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Control Method:

  Select Elimination Substitution Isolation Engineering Controls Administrative Controls PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering Controls
  • Administrative Controls
  • PPE

• Control Method Notes:

• Add Photo

  Media

• Likelihood After:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence After:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Notes

• Electrical Leads / Portable Tools

  Risk

  Safe

  N/A

• Risk:

• Add Photo

  Media

• Likelihood Before:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence Before:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Control Method:

  Select Elimination Substitution Isolation Engineering Controls Administrative Controls PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering Controls
  • Administrative Controls
  • PPE

• Control Method Notes:

• Add Photo

  Media

• Likelihood After:

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence After:

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Notes

Other Hazards

• Add Risk

Custom Risk

• Risk:

• Add Photo

  Media

• Likelihood: Before

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence: Before

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Control Method:

  Select Elimination Substitution Isolation Engineering Controls Administrative Controls PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering Controls
  • Administrative Controls
  • PPE

• Control Method Notes:

• Add Photo

  Media

• Likelihood: After

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Consequence: After

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• Notes:

Sign Off:

• Sign:

  Sign

• Additional Worker

Additional Worker

• Sign:

  Sign