Take 5

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

Purpose

• What are you doing onsite?

  Product Demo

  Training

  Product Installation

  Product Testing

  Other

• Please specify

Induction

• Has your visit to this site been registered (eg signed visitor book)?

  Yes

  No

• Please see your site contact for this information and restart the audit

• Have you been inducted to the site?

  Yes

  No

• Please see your site contact for this information and restart the audit

• Are you aware of the emergency procedures incl evacuation point?

  Yes

  No

• Please see your site contact for this information and restart the audit

• Do you know who and how to report hazards or injuries onsite?

  Yes

  No

• Please see your site contact for this information and restart the audit

• Please see your site contact for this information !!!

TAKE 5 & THINK ABOUT THE TASK

• Do you clearly understand the job that you'll be doing?

  Yes

  No

• Contact your supervisor before proceeding !!!

• Are you authorized and competent to do the task?

  Yes

  No

• Contact your supervisor before proceeding !!!

• Have you inspected the area you'll be working in?

  Yes

  No

• Please see your site contact for this information !!!

• Have you identified any hazards

  No

  Yes

• No hazards identified, please finish audit and proceed

• HAZARD

• Risk after control(s) have been implemented

  High

  Medium

  Low

• STOP, the risk must be reduced before your work can proceed. Finish audit and DO NOT proceed

• STOP, consider another control to reduce the risk to LOW.

• Low risk, please finish audit and proceed