Fillable TAKE 5 PRE-START CHECKLIST Please tick

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TAKE 5 PRE-START CHECKLIST Please tick

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TAKE 5 PRE-START CHECKLIST
This checklist will help workers and contractors who are working on new or external worksites reduce their exposure
to health and safety risks and hazards. It should take 5 minutes to complete before starting work.
Date:
Time:
Name:
Location/Job:
Supervisor/Manager:
Tasks to be performed:
Please tick
No.
Question?
Yes
No
NA
1
Have you signed in to the site?
2
Do you have to do an induction?
3
Do you need to be accompanied while on site?
4
Do you know the site’s health and safety rules?
5
Are you familiar with security arrangements and the system for reporting incidents/near
misses and hazards?
6
Are there emergency facilities and an evacuation procedure/route for the site?
7
Do you have access to appropriate emergency and first aid equipment?
8
Have you asked the person in charge about all relevant hazards?
9
If the work involves a high-risk task (such as work at heights, hot-work, confined spaces), is
a work permit/safe work method statement required?
10
Do you have the correct procedures and equipment to do the work safely?
11
Is there a requirement to lock/tag-out equipment or isolate/contain energy before starting
work?
12
Is there appropriate separation of vehicles and people during the proposed work?
13
Is all required electrical/mechanical equipment in a safe condition?
14
Are hazardous/dangerous substances used and stored according to their safety data
sheets?
15
Have you consulted with workers about the task and the safe way to do it?
16
Do you have all necessary PPE?
17
Have you got a safe way of getting in and out of your work area?
18
Have any manual handling risks been identified and accessed?
If you answer “no” to any of those above, you may need to follow up with the site supervisor before you start work to
help ensure your safety.
At the end of work:
No.
Question?
Yes
No
NA
19
Have you left the worksite in an appropriate condition free from hazards and risks
(clean-up, tools put way, housekeeping)?
20
If required, have you signed out?
Return this checklist to your manager/supervisor after work is complete.
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Completed 8 September 2021

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