Title Page
-
Document No.
-
Client / Site
-
Conducted on
-
Prepared by
-
Location
-
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>
DO NOT PROCEED WITH THE TASK. You have selected NO to the above question (Is there a procedure for the task) If the task does not require a JSA select N/A Contact you supervisor and discuss the changes.
-
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
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 ?) Please contact your supervisor to discuss.
-
Am I trained, competent and authorized <br>For this task ?
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 ?
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 ?
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 ?
-
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 ) ?
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 ?
-
Access the risk and give a Description of hazard
-
Controls implemented to reduce the risk
-
Does my task impact others ?
-
Access the risk and give a Description of hazard
-
Controls implemented to reduce the risk
-
Do I have safe access and egress ?
-
Access the risk and give a Description of hazard
-
Controls implemented to reduce the risk
-
Can I slip or trip ?
-
Access the risk and give a Description of hazard
-
Controls implemented to reduce the risk
-
Can I strain or over exert my self
-
Access the risk and give a Description of hazard
-
Controls implemented to reduce the risk
-
Can I fall from a height ?
-
Access the risk and give a Description of hazard
-
Controls implemented to reduce the risk
-
Can I be trapped/caught by plant ?
-
Access the risk and give a Description of hazard
-
Controls implemented to reduce the risk
-
Can something fall on me or others ?
-
Access the risk and give a Description of hazard
-
Controls implemented to reduce the risk
-
Is there a Fire Risk ?
-
Access the risk and give a Description of hazard
-
Controls implemented to reduce the risk
-
Do I need help with this task ?
-
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 ?
-
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
