ORIGINAL DATE: 04.07.
2023
REVISION DATE: N/A
OHS MANAGEMENT SYSTEM
REV No: 0
DAILY SAFE TASK INSTRUCTION (DSTI) / PRE-WORK ISSUE DATE: 01.11.2023
ASSESSMENT REF CLAUSE: 6.1
Form No. KP-CON-OHS-SP01-F03 Page 1 of 7
Supervisor / Responsible
Work Area / Section: Company:
person:
Date: Time: Task / Activity:
Risk Assessment/s applicable to task (RA Numbers):
Machinery, Equipment and Tools required for Task:
“Contractor Team” (Identify all aspects associated with the task and confirm controls are in place. Management Overview (Confirm controls are in
Remember the 5-point safety system. Hierarchy of controls: place, effective and identify areas for additional
i. Check the entrance to the place of work. 1) Elimination, 2) Substitution 3) Engineering / Isolation, action)
ii. Are working place and equipment in good order? 4) Administration, 5) Personal Protective Equipment.
iii. Are people working properly?
iv. Do an act of safety.
v. Can, and will, people continue to work properly?
Items verified To If “No”, Action Action completed Findings Improvement Sign-off
Standard Plan. (Initials, Date & (OK/ Def) Actions and
(Yes/No/NA) Time) Comments
Safe access to work area (clean & tidy)
SMI board in area (R/A’s, Permits, Emergency Details)
Barricading (correct type, condition, access)
Excavations (battered, shored)
Condition of tools & equipment (checklist and tagged)
Required PPE (Utilised and in good condition)
Hard hat/eye protection/ear protection/overalls/gloves/boots/dust mask etc.
Dedicated roadways and walkways
Scaffolding and ladders (Inspected, tagged and secure)
Elevated work (Access restricted below, Harnesses, lifelines, tools secured)
Valid Permits / Special permission required: (Hot work/Confined space/Excavation etc.)
First aid equipment (available and in good condition)
Firefighting equipment (available and serviceable condition)
Lock –out/s required and in place.
e.g., Electricity, Tension, Compressed air, Water, Hydraulic Pressure, Steam.
Interphase between contractors whose activities affect each other.
Date Printed: 08/04/2025
Uncontrolled Copy. This document is controlled only in electronic format on SharePoint. Once printed, it is valid as a record only. Refer to
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ORIGINAL DATE: 04.07.2023
REVISION DATE: N/A
OHS MANAGEMENT SYSTEM
REV No: 0
DAILY SAFE TASK INSTRUCTION (DSTI) / PRE-WORK ISSUE DATE: 01.11.2023
ASSESSMENT REF CLAUSE: 6.1
Form No. KP-CON-OHS-SP01-F03 Page 2 of 7
Hazards Identified
Control task / Action Plan / Responsibility /
No Main Steps for Task (Any changes noted during activity, please add Comments
Recommendations By Whom
hazards)
AREA: _____________________DATE: ____/____/202___ Hierarchy of controls: 1) Elimination, 2) Substitution 3) Engineering / Isolation, 4) Administration, 5) Personal Protective Equipment.
AREA: _____________________DATE: ____/____/202___ Hierarchy of controls: 1) Elimination, 2) Substitution 3) Engineering / Isolation, 4) Administration, 5) Personal Protective Equipment.
Date Printed: 08/04/2025
Uncontrolled Copy. This document is controlled only in electronic format on SharePoint. Once printed, it is valid as a record only. Refer to
Karo Platinum SharePoint for the latest and controlled version.
ORIGINAL DATE: 04.07.2023
REVISION DATE: N/A
OHS MANAGEMENT SYSTEM
REV No: 0
DAILY SAFE TASK INSTRUCTION (DSTI) / PRE-WORK ISSUE DATE: 01.11.2023
ASSESSMENT REF CLAUSE: 6.1
Form No. KP-CON-OHS-SP01-F03 Page 3 of 7
Hazards Identified
Control task / Action Plan / Responsibility /
No Main Steps for Task (Any changes noted during activity, please add Comments
Recommendations By Whom
hazards)
Date Printed: 08/04/2025
Uncontrolled Copy. This document is controlled only in electronic format on SharePoint. Once printed, it is valid as a record only. Refer to
Karo Platinum SharePoint for the latest and controlled version.
ORIGINAL DATE: 04.07.2023
REVISION DATE: N/A
OHS MANAGEMENT SYSTEM
REV No: 0
DAILY SAFE TASK INSTRUCTION (DSTI) / PRE-WORK ISSUE DATE: 01.11.2023
ASSESSMENT REF CLAUSE: 6.1
Form No. KP-CON-OHS-SP01-F03 Page 4 of 7
Pre-Work Assessment Attendance Register: Date: ___/___/202__
I, the undersigned acknowledge and declare that I took part in all hazards, risks and control measures as detailed in the attached Pre-Work Assessment and the
above was discussed and explained in full detail to me by my supervisor / team leader / team members and communicated in the language I understand. I
understand the whole content of the document and accept accountability for any of my actions contrary to this document.
NB: Discuss task/job assessment with all involved workers. Remember to reassess if there is a change in plan or circumstances! Examples of change: new
employee joining team, change in ground / environmental conditions, change of equipment, change in supervision, new hazards identified etc.
When applicable: Language interpreted from:_______________________________ to ________________________________
Employees Present
First Name Surname Signature First Name Surname Signature
1 17
2 18
3 19
4 20
5 21
6 22
7 23
8 24
9 25
10 26
11 27
12 28
Date Printed: 08/04/2025
Uncontrolled Copy. This document is controlled only in electronic format on SharePoint. Once printed, it is valid as a record only. Refer to
Karo Platinum SharePoint for the latest and controlled version.
ORIGINAL DATE: 04.07.2023
REVISION DATE: N/A
OHS MANAGEMENT SYSTEM
REV No: 0
DAILY SAFE TASK INSTRUCTION (DSTI) / PRE-WORK ISSUE DATE: 01.11.2023
ASSESSMENT REF CLAUSE: 6.1
Form No. KP-CON-OHS-SP01-F03 Page 5 of 7
13 29
14 30
15 31
16 32
Absent Employees
1 4 7
2 5 8
3 6 9
I, the undersigned acknowledge that I have read and fully understand all area related hazards, risks and control measures as detailed in the attached Pre-Work
Assessment above.
Visitors to area
First Name Surname Company Signature
Date Printed: 08/04/2025
Uncontrolled Copy. This document is controlled only in electronic format on SharePoint. Once printed, it is valid as a record only. Refer to
Karo Platinum SharePoint for the latest and controlled version.
ORIGINAL DATE: 04.07.2023
REVISION DATE: N/A
OHS MANAGEMENT SYSTEM
REV No: 0
DAILY SAFE TASK INSTRUCTION (DSTI) / PRE-WORK ISSUE DATE: 01.11.2023
ASSESSMENT REF CLAUSE: 6.1
Form No. KP-CON-OHS-SP01-F03 Page 6 of 7
I hereby certify that the above items were verified, and the task and associated Hazards and Risks discussed with all workers under my supervision prior to
commencement of work. SHORT INTERVAL RISK CONTROL MEASURE. MUST BE COMPLETED AND SIGNED OFF AFTER CHECKING THE FILLED FORM
Responsible Personnel: First Name Surname Time Signature Comments
Direct / Line Supervisor:
Team Safety Representative:
Head of Section /
Contractor Site manager:
Company Safety Officer:
Other:
Notes / Items to be addressed:
Date Printed: 08/04/2025
Uncontrolled Copy. This document is controlled only in electronic format on SharePoint. Once printed, it is valid as a record only. Refer to
Karo Platinum SharePoint for the latest and controlled version.
ORIGINAL DATE: 04.07.2023
REVISION DATE: N/A
OHS MANAGEMENT SYSTEM
REV No: 0
DAILY SAFE TASK INSTRUCTION (DSTI) / PRE-WORK ISSUE DATE: 01.11.2023
ASSESSMENT REF CLAUSE: 6.1
Form No. KP-CON-OHS-SP01-F03 Page 7 of 7
Post-Work Assessment - Close-out
To be completed at the end of the task or shift
To Standard If “No”, Action Plan
Items to be verified Comments
(Yes/No/NA)
Area access reinstated where applicable
Housekeeping in order and area safe
All excavations properly barricaded
All tools and equipment removed and stored safely
All equipment remaining in working area secured, energy released and safe
No loose items on elevated heights
Confirmed no smouldering material after hot work
All safe scaffold tags removed and replaced with “Not safe for use red tags”
All isolation and lockouts removed where applicable
All permits returned to the originator and signed-off where applicable
I hereby confirm that the above items were checked in my area of responsibility and the area/s is safe and free of any possible hazards
Name Surname Date Time Signature Comments
Supervisor
Date Printed: 08/04/2025
Uncontrolled Copy. This document is controlled only in electronic format on SharePoint. Once printed, it is valid as a record only. Refer to
Karo Platinum SharePoint for the latest and controlled version.
