TVE Take 5

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

TAKE 5 STOP THINK ABOUT THE TASK Please take the time and complete the 18 questions.

• Is there a procedure for this task ( i.e JSA, SWMS, High Risk SWMS ) ?<br>

  Yes

  No

  N/A

• Please selected below the following High risk SWMS required. HR SWMS are located in a PDF version in iBooks and in your vehicle
  WHS folder.
  

• HR SWMS 01 Working at height

• HR SWMS 08 working on live electrical circuits

• Is there a change to the design, procedure, process or task

  Yes

  No

  N/A

• Yes

  No

  N/A

DO NOT PROCEED WITH THE TASK. You have selected YES to the above question (Is there a change to the design, procedure, process or task). Contact you supervisor and discuss the changes.

• Am I trained, competent and authorized <br>For this task ?

  Yes

  No

  N/A

DO NOT PROCEED WITH THE TASK. You have selected NO to the above question (Am I trained, competent and authorized for this task ?) Please contact your supervisor to discuss.

• Do I have the correct PPE and equipment for this task ?

  Yes

  No

  N/A

DO NOT PROCEED WITH THE TASK. You have selected NO to the above question (Do I have the correct PPE and equipment for this task ?) Please contact your supervisor to discuss.

• Do I have a clear plan in mind ?

  Yes

  No

  N/A

DO NOT PROCEED WITH THE TASK. You have selected NO to the above question ( Do I have a clear plan in mind ?) Please contact your supervisor to discuss.

IDENTIFY THE HAZARDS.

• Do I have to isolate to control sources of energy ?

  Yes

  No

  N/A

• Access the risk and give a Description of hazard

• Controls implemented to reduce the risk

• Am I fit to perform this task ( aware, rested,alert, not under the influence of<br>Drugs or Alcohol ) ?

  Yes

  No

  N/A

DO NOT PROCEED WITH THE TASK. You have selected NO to the above question (Am I fit to perform this task ( aware, rested,alert, not under the influence of Drugs or Alcohol ) ? ) Please contact your supervisor to discuss.

• Could the Atmospheric conditions be unsafe ?

  Yes

  No

  N/A

• Access the risk and give a Description of hazard

• Controls implemented to reduce the risk

• Does my task impact others ?

  Yes

  No

  N/A

• Access the risk and give a Description of hazard

• Controls implemented to reduce the risk

• Do I have safe access and egress ?

  Yes

  No

  N/A

• Access the risk and give a Description of hazard

• Controls implemented to reduce the risk

• Can I slip or trip ?

  Yes

  No

  N/A

• Access the risk and give a Description of hazard

• Controls implemented to reduce the risk

• Can I strain or over exert my self

  Yes

  No

  N/A

• Access the risk and give a Description of hazard

• Controls implemented to reduce the risk

• Can I fall from a height ?

  Yes

  No

  N/A

• Access the risk and give a Description of hazard

• Controls implemented to reduce the risk

• Can I be trapped/caught by plant ?

  Yes

  No

  N/A

• Access the risk and give a Description of hazard

• Controls implemented to reduce the risk

• Can something fall on me or others ?

  Yes

  No

  N/A

• Access the risk and give a Description of hazard

• Controls implemented to reduce the risk

• Is there a Fire Risk ?

  Yes

  No

  N/A

• Access the risk and give a Description of hazard

• Controls implemented to reduce the risk

• Do I need help with this task ?

  Yes

  No

  N/A

• Access the risk and give a Description of hazard. You have selected yes to the above question ( Do I need help with the task ? ) Please Contact your supervisor to discuss.

• Controls implemented to reduce the risk

• Any other concerns or hazards ?

  Yes

  No

  N/A

• Make a list of your concerns / hazards and contact your Supervisor.

• Access the risk and give a Description of hazard

• Controls implemented to reduce the risk

• Add signature

  Sign