Take 5 Inspection
General Information
Company Name
Date
Specific Location
Task
Before Starting Work
Have you received induction training?
Do you know the company’s health & safety rules?
Are you familiar with how to report hazards & incidents?
Are there emergency facilities and an evacuation procedure/route for the site?
Do you have the correct procedures and equipment to do the work safely?
Have any manual handling risks been identified and accessed?
Are hazardous/dangerous substances used and stored according to their safety data sheets?
Have you asked the person in charge about all relevant hazards?
If you answer “no” to any of those above, you may need to follow up with the person in charge before you start work to help ensure your safety.
Identify and Assess the Hazards
Hazard type
Take or attach photo evidence of hazard identified
Description
At the End of Work
Have you left the worksite in an appropriate condition free from hazards and risks (clean-up, tools put way, housekeeping)?
Comments
Signature
