Smart Form DirectoryTake 5 Risk Assessment Powered by Bedrock Solutions SmartForm Take 5 Risk Assessment Checklist Date Carried Out Time When Started Task Description * Photo of Work Environment * Drop a file here or click to upload Choose File Maximum file size: 67.11MB Take More Photos? * No Yes Additional Photos (5 max) * Drop a file here or click to upload Choose File Maximum file size: 67.11MB Pre-Checks Does everyone clearly understand what the task is? * Yes No Not Applicable Action to be taken? * Is everyone trained to do the work and are familiar with the equipment/ task? * Yes No Not Applicable Action to be taken? * Are the tools and equipment in a safe condition? * Yes No Not Applicable Action to be taken? * Is the approved documentation for the task read and understood? * Yes No Not Applicable Action to be taken? * Is everyone safe from other activities / tasks in the area? * Yes No Not Applicable Action to be taken? * Have you notified other people who may be affected by your work? * Yes No Not Applicable Action to be taken? Are all hazards associated with the task identified? * Yes No Not Applicable Action to be taken? Have all hazard controls been implemented? * Yes No Not Applicable Action to be taken? * Are all potential issues discussed and understood by all? * Yes No Not Applicable Action to be taken? * Can the task proceed safely? * Yes No Not Applicable Action to be taken? * Any other observations/comments? * Yes No Other observations/comments * Sign off Details Completed By: Signature * signature keyboard Clear Declaration that all pre-use checks have been carried out to the best of my ability Are you carrying out this task on your own? * Yes No Team Member Sign off Full Name * Signature * signature keyboard Clear plus1 Add minus1 Remove Select company person/s to email * If you are human, leave this field blank. Submit