VS-HSC-042 v1

• Job Number

• Task

• SHEWMS Reference

• Conducted on

  Date

• Person Completing Start Card

• Location
  Address

• The Start Card must be completed by each individual following the Pre Start Meeting prior to starting work or restarting site work or when moving to another work site, or when planned work processes or work conditions change.
  Before entering any potentially hazardous, uncontrolled or unknown work environments;
  Prior to performing work that is new, not routine or unfamiliar in any workplace.
  

• Workflow

  

Stop and think through the task

• You must contact your supervisor if any box turns red.

• A. Have I signed and do I understand the SHEWMS for this task?

  Yes

  No

  N/A

• B. Is there a change to a procedure, process or design?

  No

  Yes

  N/A

• C. Do I have the required permits and approvals?

  Yes

  No

  N/A

• D. Am I trained, competent and authorised to complete this task?

  Yes

  No

  N/A

• E. Am I wearing the correct PPE for the task?

  Yes

  No

  N/A

• F. Are tools and equipment in good working order, tested/tagged and safe to use?

  Yes

  No

  N/A

• G. Have I signed onto the Pre-start/JSEA Meeting Form today and have I been briefed on the task?

  Yes

  No

  N/A

Task Readiness

• You must contact supervisor if any box turns red.

• 1. Am I fit to perform this task (aware, rested, alert and physically able)?

  Yes

  No

  N/A

• 2. Am I under the influence of drugs and alcohol?

  No

  Yes

  N/A

• 3. Do I need additional help with the task?

  No

  Yes

  N/A

• 4. Do I understand the directions given by my supervisor?

  Yes

  No

  N/A

• 5. Is my immediate work area neat and tidy (clear access and egress)?

  Yes

  No

  N/A

• 6. Do I have response plans in place for a potential emergency?

  Yes

  No

  N/A

• 7. Am I able to effectively implement the risk control measures identified in the SHEWMS and JSEA?

  Yes

  No

  N/A

• 8. Are there any other safety or environmental hazards associated with this task that are not covered in the SHEWMS and/or Pre-start/JSEA Form?

  Yes

  No

• Please complete the following hazard control form section. Attempt to select "Above the Line" controls where possible.

  

• Examples

  

• Likelihood and Consequence

  

• Risk Matrix

  

• Hazard Control Form

Hazard Control

• Hazard

• Control

• Residual Risk Rating after my Control has been applied

• 9. Have I achieved an acceptable risk rating and do I feel safe to carry out the task?

  Yes, I feel safe.

  No

• Signature

  Sign