Terratree's_Stop-Take 5

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Time Take 5 Checklist completed

  Date

STOPS

• Is this task part of a Job?

  Yes

  No

  N/A

THINK

• Is there a work instruction for this task?

  Yes

  No

  N/A

• Has this task been identified in my JHA?

  Yes

  No

  N/A

• Does this task present any immediate hazards to myself or others nearby?

  Yes

  No

  N/A

• Am I trained to do this task?

  Yes

  No

  N/A

IDENTIFY

• Have I communicated with other work groups any hazards that may affect them or me?

  Yes

  No

  N/A

• Are the controls from my JHA in place?

  Yes

  No

  N/A

• What hazards are around me "here and now"?

  Yes

  No

  N/A

• What is the HAZARD/S?

• undefined

• What are the CONTROL/S?

• undefined

PLAN

• Do I have all the permits required for this task?

  Yes

  No

  N/A

• Do I have the correct tools & equipment?

  Yes

  No

  N/A

• Is the equipment isolated and I applied my red locks (if required)

  Yes

  No

  N/A

PROCEED

• Operator Signature

  Sign