Take 5 Name* Date* DD slash MM slash YYYY Location* Elemera Karratha WA Elemera Kewdale WA Exio Kewdale WA Inlex Karratha WA Inlex NT Inlex Perth WA Safehouse Karratha WA Safehouse Kewdale WA Safehouse NT TaskTask* Please write descriptive task / activity for AI Risk EvaluationHiddenRisk Evaluation (AI) HiddenTask (debug) Potential risks / issues: Suggestions for mitigations: Best scenarios: 1 - REVIEW THE TASKI understand the task, scope, and steps required to carry out this task?* Yes No My tools and equipment are fit purpose and in good working order?* Yes No I have the correct PPE for this task?* Yes No I have the necessary work permits/certificates (e.g. Hot work, Confined Space, Working at Heights, Excavations) for this task?* Yes No I have a clear plan in mind?* Yes No I am trained / qualified to perform this task* Yes No If you have answered “NO” to any of the above? STOP; you MUST check with your supervisor!2 - STOP THE HAZARDSWill I be working on equipment with guards removed?* Yes No Will I be performing a task that requires Plant / Equipment to be ISOLATED?* Yes No Am I or others at risk from plant/equipment in the vicinity or the operation of this plant/equipment?* Yes No Does the task involve hazardous materials?* Yes No Will I be performing a task without an existing isolation procedure?* Yes No Will I be working in a confined space and/or at heights?* Yes No HiddenAre there Hazards involved in what I am about to do? (List on section 4 - Control the Hazard) Yes No If you have answered “YES” to any of the above? STOP; you MUST check with your supervisor!3 - ASSESS THE RISKShould I stop the job and reassess what I am doing?* Yes No N/A Warning: A JHA must be completed4 - CONTROL THE HAZARDWhat controls have I put in place to complete the task safely? What are the Controls in place to manage any identified Hazards? List the hazardsHazardControl for Hazard 5 - DO IT SAFELYDo I know the Hazard Controls are working?* Yes No Can you complete the task SAFELY?* Yes No See your Supervisor, do not commence the job