Information
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Take 5: Lifesaving Behaviors
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Prepared by
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Conducted on
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Customer Name:
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Location City/State
Take 5 Assessment
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For any failed response (noted in red) please explain in the box below the question. i.e. Can I put controls in place to manage this hazard? Attachments may be added if necessary, to better explain the situation.
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PAUSE and ask for help from your Manager if a condition is not safe, or you cannot take action to eliminate the hazard. If a near miss occurs, report it in a timely manner to your Manager.
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When troubleshooting, ensure that hazardous energy is controlled as soon as the problem is identified and a repair is going to take place.
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1. I wear my seat belt when driving vehicles?
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Wearing your seatbelt is a Terex Life Saving Behavior. You must change your habit!
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2. Do I have the proper PPE (Personal Protective Equipment) to do my job safely?
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3. Did I check in with the onsite representative?
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4. Can I position myself in a safe zone in relation to moving equipment?
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5. Can I protect myself against falls from height?
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6. Can I verify isolation, by an authorized person, - lock, tag, and try - when work involves hazardous energy?
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7. Can I effectively secure equipment from accidental movement (i.e. stable ground conditions for outriggers, chock or block wheels, cribbing, blocking raised jibs)?
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8. Can I stand clear of the danger Zone from unstable / suspended loads?
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11. Can I work safely in the present weather conditions (weather, heat, etc.)?
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12. My work area is clear of any obstructions (power lines, extension cords, air hoses, proper clearance for extending boom or scissor, etc.)?
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13. Do I know where to go in the event of a facility emergency and I have access to assistance in case of an emergency for myself?
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14. Can I prevent spills and other environmental hazards (oil spills, aerosols, etc.)?
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15. This job requires entry into a confined space?<br>
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Confined Space entries are not allowed, you must Pause the Job. Contact your supervisor.
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If additional hazards are present or possible, please explain hazard and how to manage it:
