Take 5 Checklist
Download the checklist as a PDF or as an excel file (Scroll down the page).
What's in the Take 5 Checklist?
| Name | Text |
| Location | Text |
| Task | Text |
| Am I clear on what the task is? | Yes/No |
| Do I have the required skills, training, and licenses for the task? | Yes/No |
| Have I checked the JSA/JHA/SWMS/procedures for the task? | Yes/No |
| Is all my equipment and tools correct and in good order? | Yes/No |
| Do I have the necessary permits for the task? | Yes/No |
| Do I have the correct personal protective equipment? | Yes/No |
| Manual Handling (e.g. Lifting, awkward positions, impacts, over-exertion) | Yes/No |
| Gravity (e.g. Slips, trips and falls and struck by falling objects) | Yes/No |
| Mechanical (e.g. Caught in moving parts, struck by plant or flying objects) | Yes/No |
| Electrical (e.g. Electrocution from faulty tools or working close to live power) | Yes/No |
| Chemical (e.g. Inhaling, swallowing or touching acid, solvents) | Yes/No |
| Pressure (e.g. Contact with highly pressurised fluid/gas or air) | Yes/No |
| Exposure (e.g. to noise, dust, fumes, chemicals, asbestos or extreme weather) | Yes/No |
| Biological (e.g. Contracting diseases e.g. Hepatitis and Legionnaires) | Yes/No |
| Radiation (e.g. Exposure to radiation such as x-rays, sunlight or ultra-violet) | Yes/No |
| Psychological (e.g. Stress, violence, fatigue, depression) | Yes/No |
| Other Hazards (e.g. Silica, asphyxiation) | Yes/No |
| Risks understood and worked out? | Yes/No |
| SWMS completed for risks identified? | Yes/No |
| Safe to proceed? | Yes/No |
Get the Printable Take 5 Checklist:
- Download the Printable Take 5 Checklist as a PDF file -
Take 5 Checklist.pdf - Download the Printable Take 5 Checklist as an Excel file -
Take 5 Checklist.xls - View the Take 5 Checklist as a webpage -
Take 5 Checklist.html - Print a Take 5 Checklist QR Code -
Take 5 Checklist.qrcode
Questions?
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