Take 5

• Document No.

• Audit Title

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

• Do I have the required skills and knowledge?

  Yes

  No

  N/A

• Does a procedure exist?

  Yes

  No

  N/A

• Do I understand the steps required to do the job?

  Yes

  No

  N/A

• Do I have the correct PPE?

  Yes

  No

  N/A

• Have I got a clear plan in mind?

  Yes

  No

  N/A

Hazard Checklist

• Have I considered/Am I at risk from:

• People Hazards

• Awkward posture

• Repetitive movements

• Manual handling (lifting, lowering, pushing, pulling)

• Others working around me (above & below)

• Fatigue

• Mechanical hazards

• Accidental startup

• Mobile equipment

• rolling machinery

• Rotating components

• Pinch points

• Gravitational Hazards

• Working at heights

• Falling Objects

• Heavy equipment or tools

• Noise and vibrations

• Rockfalls and landslides

• Environmental Hazards

• Stored Energy

• Chemical

• Electrical

• Biological

• Radiation

• Other

• Poor Housekeeping

• Poor visability

• Wet, slippery and unstable surfaces

• Noise and vibrations

• Heat and extreme temperatures

• Exhaust fumes and gases

• Working in a confined space

• Poor weather

• Other Hazards

2. Look for Hazards

• Have I completed a Hazard Checklist?

  Yes

  No

  N/A

• MUST COMPLETE THE HAZARD CHECKLIST

• Will I be i be operating equipment with guards removed?

  Yes

  No

  N/A

• DO NOT PROCEED - SEE YOUR SUPERVISOR AND COMPLETE A JOB SAFETY ANALYSIS

• Am I or other at risk from the operation of mobile equipment or machinery?

  Yes

  No

  N/A

• DO NOT PROCEED - SEE YOUR SUPERVISOR AND COMPLETE A JOB SAFETY ANALYSIS

• Is there a manual handling risk?

  Yes

  No

  N/A

• DO NOT PROCEED - SEE YOUR SUPERVISOR AND COMPLETE A JOB SAFETY ANALYSIS

• Will I be isolating without a procedure?

  Yes

  No

  N/A

• DO NOT PROCEED - SEE YOUR SUPERVISOR AND COMPLETE A JOB SAFETY ANALYSIS

• Will I be working at height or in a confined space?

  Yes

  No

  N/A

• DO NOT PROCEED - SEE YOUR SUPERVISOR AND COMPLETE A JOB SAFETY ANALYSIS

3. Assess the Risk

• What is the risk level

  Low

  Medium

  High

• Have I controlled all hazards so I will be safe?

  Yes

  No

• Do the job safely

• DO NOT PROCEED - SEE YOUR SUPERVISOR AND COMPLETE A JOB SAFETY ANALYSIS

• Have I controlled all hazards so I will be safe?

  Yes

  No

• Do the job safely

• DO NOT PROCEED - SEE YOUR SUPERVISOR AND COMPLETE A JOB SAFETY ANALYSIS

• DO NOT PROCEED - SEE YOUR SUPERVISOR AND COMPLETE A JOB SAFETY ANALYSIS

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