VizcomTake 5 - BEFORE TASK CHECKLIST

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Time Take 5 Checklist completed

  Date

STOP! Think through the task.

• Am I clear on what the task is?

  Yes

  No

  N/A

• Do I have the required skills,training and licenses for the task.

  Yes

  No

  N/A

• Is there a safe work method statement available.

  Yes

  No

  N/A

• Is a work permit and or authority to work required?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Do I have the correct personal protective equipment?

  Yes

  No

  N/A

Look for the Hazards

• Are there any Biological Hazards?

  Yes

  No

• Make an assesment of the risk level present.

• What is the risk level?

  Low

  Moderate

  High

  Extreme

• Complete/ update SWMS for task. (seek assistance from supervisor)

• Are there any Chemical Hazards?

  Yes

  No

• Make an assesment of the risk level present.

• What is the risk level?

  Low

  Moderate

  High

  Extreme

• Complete/ update SWMS for task. (seek assistance from supervisor)

• Are there any Electrical Hazards?

  Yes

  No

• Make an assesment of the risk level present.

• What is the risk level?

  Low

  Moderate

  High

  Extreme

• Complete/ update SWMS for task. (seek assistance from supervisor)

• Are there any Manual handling Hazards?

  Yes

  No

• Make an assesment of the risk level present.

• What is the risk level?

  Low

  Moderate

  High

  Extreme

• Complete/ update SWMS for task. (seek assistance from supervisor)

• Are there any Atmospheric Hazards?

  Yes

  No

• Make an assesment of the risk level present.

• What is the risk level?

  Low

  Moderate

  High

  Extreme

• Complete/ update SWMS for task. (seek assistance from supervisor)

• Are there any External Hazards?

  Yes

  No

• Make an assesment of the risk level present.

• What is the risk level?

  Low

  Moderate

  High

  Extreme

• Complete/ update SWMS for task. (seek assistance from supervisor)

• Are there any Environmental Hazards?

  Yes

  No

• Make an assesment of the risk level present.

• What is the risk level?

  Low

  Moderate

  High

  Extreme

• Complete/ update SWMS for task. (seek assistance from supervisor)

• Are there any Fire/ Explosion Hazards?

  Yes

  No

• Make an assesment of the risk level present.

• What is the risk level?

  Low

  Moderate

  High

  Extreme

• Complete/ update SWMS for task. (seek assistance from supervisor)

• Are there any Gravitational Hazards?

  Yes

  No

• Make an assesment of the risk level present.

• What is the risk level?

  Low

  Moderate

  High

  Extreme

• Complete/ update SWMS for task. (seek assistance from supervisor)

• Are there any Machanical Hazards?

  Yes

  No

• Make an assesment of the risk level present.

• What is the risk level?

  Low

  Moderate

  High

  Extreme

• Complete/ update SWMS for task. (seek assistance from supervisor)

• Are there any Psycho social Hazards?

  Yes

  No

• Make an assesment of the risk level present.

• What is the risk level?

  Low

  Moderate

  High

  Extreme

• Complete/ update SWMS for task. (seek assistance from supervisor)

• Are there any Pressure Hazards?

  Yes

  No

• Make an assesment of the risk level present.

• What is the risk level?

  Low

  Moderate

  High

  Extreme

• Complete/ update SWMS for task. (seek assistance from supervisor)

• Are there any Thermal Hazards?

  Yes

  No

• Make an assesment of the risk level present.

• What is the risk level?

  Low

  Moderate

  High

  Extreme

• Complete/ update SWMS for task. (seek assistance from supervisor)

• Are there any Atmospheric Hazards?

  Yes

  No

• Make an assesment of the risk level present.

• What is the risk level?

  Low

  Moderate

  High

  Extreme

• Complete/ update SWMS for task. (seek assistance from supervisor)

Assess the hazards

• What is the risk level?

  Low

  Moderate

  High

  Extreme

• Complete/ update SWMS for task. (seek assistance from supervisor)

Make the Hazard Safe

• Are all hazards removed or at a low risk level?

  Yes

  No

• WARNING! A hazard report must be completed before work can continue!

• Does this all feel right?

  Yes

  No

• IMPORTANT!! please discuss any concerns before task continues.

Hazard Report

• Complete the fields below for any hazards present. Use the risk score calculator provided.

  

• Describe Hazard 1

• What is the intial risk level?

  Low

  Moderate

  High

  Extreme

• List the controls used to reduce the risk level.

• What is the retained risk level?

  Low

  Moderate

  High

  Extreme

• Describe hazard 2

• What is the intial risk level?

  Low

  Moderate

  High

  Extreme

• List the controls used to reduce the risk level.

• What is the retained risk level?

  Low

  Moderate

  High

  Extreme

• Describe hazard 3

• What is the intial risk level?

  Low

  Moderate

  High

  Extreme

• List the controls used to reduce the risk level.

• What is the retained risk level?

  Low

  Moderate

  High

  Extreme

• Describe hazard 4

• What is the intial risk level?

  Low

  Moderate

  High

  Extreme

• List the controls used to reduce the risk level.

• What is the retained risk level?

  Low

  Moderate

  High

  Extreme

• Describe hazard 5

• What is the intial risk level?

  Low

  Moderate

  High

  Extreme

• List the controls used to reduce the risk level.

• What is the retained risk level?

  Low

  Moderate

  High

  Extreme

• List any further action required.

PROCEED

• Proceed with the task/s and if at any point in time the conditions change or a new task with risk is presented ist is essential to perform another take 5.