Online Take 5 Personal Risk Assessment - CoR
Name:
Date:
Task:
Location:
# Hazard / Risk
Yes No
1. Am I or anyone else fatigued or feeling tired?
Y
N
2. Can I strain or over exert myself?
Y
N
3. Can I come into contact with anything or any substance that may harm me (e.g. stored energy, gas, fuels, fumes?
Y
N
4. Is there anything about I can slip or trip on?
Y
N
5. Can I be caught on or in between anything?
Y
N
6. Is packing of goods or cargo involved in this task?
Y
N
7. Are loading, load restraint or unloading activities involved in this task?
Y
N
8. Is there a chance of goods or cargo becoming loose during transportation?
Y
N
9. Do I need to ensure a vehicle is road worthy?
Y
N
10. Do I need to communicate to my surrounding
workmates to make them aware of this task?
Y
N
11. Is heavy vehicle mass and dimensions applicable to this task?
Y
N
12. Are goods and cargo required to be delivered within a time frame?
Y
N
If you answered
Yes to any of the above
, you must implement controls to eliminate or reduce the risk. Please record applicable controls on the opposite page.
# Hazard
List the controls to make the job safe
Please contact your supervisor if you cannot
Eliminate
or
Reduce
the risk to a level of
“LOW”
as per the
Yellow – Low
Indicators in the Risk Score Matrix above.
Supervisor / Manager Verification
Please ensure
your supervisor or manager is informed
that he/she will be
receiving an email
asking him/her to
verify the authenticity of this Risk Assessment
including the implementation of your selected controls.
Check here to verify that you will inform your supervisor or manager of this requirement.
Please enter
your email
here (Required):
Please enter
your manager’s/supervisors name
here (Required):
Please enter
your manager’s/supervisor’s email
here (Required):
Click the submit button when you are ready.
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