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/Unit #
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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 supervisor 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 supervisor.
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1. Can I stand clear of the danger Zone from unstable / suspended loads?
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2. Can I follow my lifting plan: No Plan, No Lift?
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3. Have I inspected my crane and rigging, and is it suitable for this lift?
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4. Can I check that my interlocks and guarding work correctly on my equipment and I never bypass them?
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5. Can I position myself in a safe zone in relation to moving equipment?
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6. Can I protect myself against falls from height?
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7. Can I verify isolation - lock, tag, and try - when work involves hazardous energy?
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8. Will I pause the job if I am required to enter a confined space?<br>
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9. Do I wear my seat belt when driving to and from the job site?
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10. Can I work safely in the present weather conditions? (weather, heat, etc.)
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11. Can I prevent spills and other environmental hazards?(oil spills, aerosols, etc.)
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12. Do I have the proper PPE (Personal Protective Equipment) to do my job safely?
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If additional hazards are present or possible, please explain:
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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.
