Take5 – UGL

UGL - Take 5

First Name

Surname

Task

Date

Visual Observations

PHOTO UPLOAD

Am I fit for work and ready?

Y

N

If NO - please provide details

Am I in the area where the task is being performed?

Y

N

Is there anything new or different?

Y

N

Am I new to the task or working with anyone new?

Y

N

Could I be in the line of fire?

Y

N

Do I need to isolate?

Y

N

Do I have the correct PPE/Tools?

Y

N

BASED ON YOUR ABOVE CHOICES - Complete the following

What can injure me? (Hazards)

What can I do about it? (Controls)

I have read & agree to the Terms and Conditions of this Take 5.