Take Five

• Conducted on

  Date

• Prepared by

• Location
  Address

Take Five

• What is the Task?

• 1. Am I fit and ready to do this task?

  Yes

  No

• 2. Is there anything new or different?

  Yes

  No

• 3. Am i using the right tools/ PPE for the task?

  Yes

  No

• 4. Have i communicated with area personnel?

  Yes

  No

• 5. Can other workgroups impact on my task

  Yes

  No

• 6. Are all hazardous energies isolated?

  Yes

  No

• 7. Will any part of my body be in the line of fire?

  Yes

  No

• 8. Will the task involve an awkward posture, forceful exertion, repetition or vibration?

  Yes

  No

• 9. Can my task cause damage to the environment?

  Yes

  No

Critical Risk Management

• Does this task have one or more CRM critical risks associated with it?

  Yes

  No

• If "YES a CCC must be competed before the task step. Consider whether a JSEA would be more appropriate to manage the risk

Human Performance

• What Performance Mode Am I In

  Skills Base

  Rule Base

  Knowledge Base

Error Traps

• Error Traps For This Task

  Select Stress High work Load Time Pressure Poor Coummunications Vague or Poor Work Guidance Overconfidence Infrequent Or First Time Task Distractions First day following time off End of a Shift Or Work Cycle

  • Stress
  • High work Load
  • Time Pressure
  • Poor Coummunications
  • Vague or Poor Work Guidance
  • Overconfidence
  • Infrequent Or First Time Task
  • Distractions
  • First day following time off
  • End of a Shift Or Work Cycle

• What Tools Will I Use?

  Stop And Seek Help

  Verbilse Point & Touch

  Three Part Comms

  Step By Step

  Show And Tell

How Can I get Hurt? (Hazard/Red Zone)

• 1.

• 2.

• 3.

• 4

• 5.

What Are They Controls?

• 1.

• 2.

• 3.

• 4.

• 5.

What Are The Critical Steps For This TAsk

• 1

• 2

• 3

Under What Conditions Should I/We STOP This Task? (use your 6 sensed and remember ooppps)

Notes

• PHOTO OF LOAD IF REQUIRED

  Media

• Natalie

  N/A

  No

  Yes