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?YN
    2. Can I strain or over exert myself?YN
    3. Can I come into contact with anything or any substance that may harm me (e.g. stored energy, gas, fuels, fumes?YN
    4. Is there anything about I can slip or trip on?YN
    5. Can I be caught on or in between anything?YN
    6. Is packing of goods or cargo involved in this task?YN
    7. Are loading, load restraint or unloading activities involved in this task?YN
    8. Is there a chance of goods or cargo becoming loose during transportation?YN
    9. Do I need to ensure a vehicle is road worthy?YN
    10. Do I need to communicate to my surrounding
    workmates to make them aware of this task?    		YN
    11. Is heavy vehicle mass and dimensions applicable to this task?YN
    12. Are goods and cargo required to be delivered within a time frame?YN
    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 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.

    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