UTAS Take 5 Safety Analysis V4

TAKE 5 - Task Safety Analysis

• Document No:

• Take 5 Safety Audit for Work Request No: ( example of entry: Take 5 for WO 25647 )

• Company Name: ( example of entry: Northern Plumbing )

• Job Location: ( include Grid Reference if known )

• Short description of the task:

• Conducted on:

  Date

• Audit Undertaken by: ( name or worker or supervisor undertaking the audit )

  Select Alan Mason Barry Russell Troy Finearty Roger Wallis Greg Chandler Andrew Southorn Mike Bird Other Person

  • Alan Mason
  • Barry Russell
  • Troy Finearty
  • Roger Wallis
  • Greg Chandler
  • Andrew Southorn
  • Mike Bird
  • Other Person

• Enter name of auditor here:

1. Stop, Step back and Think

• Am I clear on what the task is?

  Yes

  No

• Do I have the required skills, training and licenses?

  Yes

  No

• Is there a JSEA or SWMS available for this task ?

  Yes

  No

• Is my equipment fit and correct for the task and in good working order?

  Yes

  No

• Do I have the correct Personal Protective Equipment for the task?

  Yes

  No

Consider the following permits

• Is a WORKING AT HEIGHTS permit required ?

  No

  Yes

• Simply define task requiring permit:

• Is a HOT WORK permit required?

  No

  Yes

• Simply define task requiring permit:

• Is a CONFINED SPACE permit required ?

  No

  Yes

• Simply define task requiring permit:

• Is a FIRE SYSTEM IMPAIRMENT permit required ?

  No

  Yes

• Simply define task requiring permit:

• Is a SURFACE PENETRATION or EXCAVATION permit required ?

  No

  Yes

• Simply define task requiring permit:

• Tick the box if you have arranged the required permits.

2. Identify the Hazards and Controls with the following JSEA

• Are there any manual handling hazards?<br>(Lifting, awkward positions, impacts or over exertion)

  No

  Yes

• What are the HAZARDS or RISKS ? List them here:

• What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

• Are there any Gravity hazards?<br>(Slips, trips and falls, or being struck by falling objects)

  No

  Yes

• What are the HAZARDS or RISKS ? List them here:

• What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

• Are there any Mechanical hazards?<br>(Caught in moving parts, struck by plant or flying objects)

  No

  Yes

• What are the HAZARDS or RISKS ? List them here:

• What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

• Are there any Electrical hazards?<br>(Faulty tools or live power)

  No

  Yes

• What are the HAZARDS or RISKS ? List them here:

• What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

• Are there any Chemical hazards?<br>(Inhalation, swallowing, acids, solvents or asbestos)

  No

  Yes

• What are the HAZARDS or RISKS ? List them here:

• What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

• Are there any High Pressure hazards?<br>(Liquid, gas or air)

  No

  Yes

• What are the HAZARDS or RISKS ? List them here:

• What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

• Are there any Noise hazards?<br>(Potential hearing damage, masking of emergency alarms)

  No

  Yes

• What are the HAZARDS or RISKS ? List them here:

• What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

• Are there any Biological hazards?<br>(Potential disease contact, ,zoonoses, animals)

  No

  Yes

• What are the HAZARDS or RISKS ? List them here:

• What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

• Are there any Radiation hazards?<br>(X-rays, sunlight, ultra violet)

  No

  Yes

• What are the HAZARDS or RISKS ? List them here:

• What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

• Are there any Environmental hazards?<br>(Dust, heat, cold, snow, ice)

  No

  Yes

• What are the HAZARDS or RISKS ? List them here:

• What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

3. Consultation with Supervisor or Manager.

• Did you consult with you or Supervisor or UTAS Contact person for items in Section 2 where you answered YES and during the JSEA preparation

  Yes

  No

• List your reason for not contacting your works Supervisor or UTAS Contact person.

4. Make the Hazards safe.

• Are all hazards now removed or at LOW level?

  Yes

  No

• Add reasons below for not reducing the hazard to a LOW risk rating:

• Where needed, I have updated the JSEA or SWMS for this task?

  Yes

  Existing OK

• Add the JSEA or SWMS title and reference number below: then forward a copy to your works Supervisor or UTAS Contact person.

5. Is the site now be SAFE so the task can be started ?

• Tick the box if you have identified and assessed all hazards and made them safe. It is now SAFE to start the work.

6. Contractor / Worker Sign Off

• Name of Person signing:

  Select Alan Mason Barry Russell Troy Finearty Roger Wallis Greg Chandler Andrew Southorn Mike Bird Other Person

  • Alan Mason
  • Barry Russell
  • Troy Finearty
  • Roger Wallis
  • Greg Chandler
  • Andrew Southorn
  • Mike Bird
  • Other Person

• Enter name of person signing this audit in the space below then select "Sign"

• Contractor / Worker Signature

  Sign