TAKE 5
Job Desc. Date
Name / JDE / SPV. Sign
STOP and evaluate your job
Have I ever done this task before?
Am I understand this job? - Is it explained well?
Do I have permission to do this job?
Do I have the required skills and familiar with the tools I've used?
Do I have the appropriate tools and in good condition?
Have I informed others who may be affected by my work?
Can I work outside the range of fire?
Have I obtained and completed the permits for this work?
Have I applied the steps before operating?
Am I fit for this job? (no fatigue, injuries, medical conditions, sleep deprivation, and medications)
IDENTIFICATION Broken Power – Inspect top/bottom/left/right
Can I complete this work without being exposed to a faulty power that might hurt me or others:
1. VEHICLES : Collision/Contact with another person, vehicle or other object
2. GRAVITATION : A person/object falls, is hit by a rolling or sliding object
3. ELECTRICITY : Contacted with electricity, low or/and high voltage
4. ENERGY STORAGE : Pressure, hydraulics, water, tension, squeezing
5. PHYSICAL CONDITION : Pushing, pulling, lifting, rigid posture, overuse of force
6. FORCE : Traction when operating the machine
7. MECHANICS : Pinching point, rotating part, stuck, impact
8. FIRE/EXPLOSIONS : Hot engine parts, explosions and flammable materials
Can I get work done without exposure to power that might affect my long-term health:
9. NOISE : Excessive noise level
10. SUBSTANCES/MATERIAL : Ingested, inhaled, absorbed, acidic/corrosive, toxic, flammable
11. BIOLOGICAL : Dust, fog, smoke, bacteria
12. HOT/COLD : Hot / Cold extreme temperature
13. RADIATION : UV Light, Radioactive Substances, Lasers
14. STRESS : Fatigue, impaired or distraction fitness for work
Can I get work done without being affected by the environment:
15. ENVIRONMENTAL : Noise, dust, light, chemical spills including wastes
HAZARD VALUES, what is the risks level?
(see Risk Rank guidance)
STOP! Report to the Supervisor or review the
Low Medium High Significant JSEA
PLANNING – What will I do?
Use risk control hierarchy and critical safety action
Hazard Value Controls to Controlling Hazards
Yes No Elimination:
Stop and seek for your supervisors
Subtitution:
Yes No Engineering:
Administration:
Yes No
PPE:
Yes No AFTER WORK IS DONE
Have I take off the Key?
REVIEW
Can the work be done differently to increase security?
e Supervisor or review the
Have I cleaned the area and left the area in good condition?
JSEA
ols to Controlling Hazards
RK IS DONE
increase security?
e area in good condition?
0.666667
8.666667