AUTHORITY TO WORK TEAM TAKE 5 ASSESSMENT BOOK

Take

AUTHORITY TO WORKTEAM TAKE 5 ASSESSMENT BOOK

5Steps to safety 5

INDIVIDUAL

centralhighlands.qld.gov.au

HAZARD MANAGEMENT FLOWCHARTHAZARD MANAGEMENT PROCESS

RISK MATRIX CONSEQUENCE

LIKELIHOOD1

Insignificant2

Minor3

Moderate4

Major5

Catastrophic

5 Almost Certain

Medium 5 Medium 10 High 15 Extreme 20 Extreme 25

4 Likely

Medium 4 Medium 8 High 12 Extreme 16 Extreme 20

3 Possible

Low 3 Medium 6 Medium 9 High 12 Extreme 15

2 Unlikely

Low 2 Low 4 Medium 6 Medium 8 High 10

1 Rare

Low 1 Low 2 Low 3 Medium 4 Medium 5

RISK RANK CRITERIA FOR RISK ACCEPTANCE RESPONSIBILITY

EXTREMERisk only acceptable with effective controls and all treatment plans to be explored and implemented where possible, managed by highest level of authority and subject to weekly continuous monitoring Quarterly reports will be provided to Council through the Audit Committee on all Extreme Risks.

CEO

HIGHRisk acceptable with effective controls, managed by senior management / executive and subject to monthly monitoring Quarterly reports will provided to Council through the Audit Committee on all High Risks.

General Manager / CEO

MEDIUMRisk acceptable with adequate controls, managed by specific procedures and subject to semi-annual monitoring

Business Unit Manager /

General Manager

LOWRisk acceptable with adequate controls, managed by routine procedures and subject to annual monitoring

Business UnitManager

STEP 1 - STOP, STEP BACK AND THINK

As a team, work your way through the 11 safety prompts. Answer each prompt by ticking either the yes or no box.

Move to the possible controls section and select the appropriate response or controls. The supervisor may be required to put further controls in place or complete the risk analysis component in step 3.

This section is mandatory and no work is to proceed until all aspects of this section are completed.

STEP 2 - IDENTIFY THE HAZARDS

As a team, identify which hazards are present in the task being assessed by ticking yes or no in the highlighted hazard categories.

If no is ticked - indicating that the hazard category is not applicable to the task being assessed, then draw a line through that category.

If yes is ticked, then complete that category as in step 1.

Should the possible control section indicate the requirement for a “HIGH RISK PERMIT”, then the supervisor must complete and issue the appropriate permit. If required a “RESCUE PLAN” is to be developed, use the Central Highlands Regional Council high risk permit process.

STEP 3 - CONTROL THE HAZARDS

To be completed if indicated in steps 1 & 2, or if a hazard control is identified outside the scope of this document.

- Transfer item number of identified hazard from first page.

- Write a brief description of the hazard identified.

- As a team, put in place control measures that will bring risk to “as low as reasonably practical” (ALARP).

- Using the hierarchy of control table, (inside the back cover) determine what level of control has been achieved.

STEP 4 - ARE THE CONTROLS EFFECTIVE

As a team, determine whether the controls in place will effectively manage the hazards involved, and are they fully implemented?

If yes, then sign off and proceed safely.

If no is ticked, further controls are to be implemented until risk levels are effectively managed to ALARP.

STEP 5 - PROCEED SAFELY

Once this assessment has been fully completed (in conjunction with SWMS and/or permits), then it is in effect the “Authority to Work” on the task/s assessed.

Ensure that if conditions change or hazards emerge or evolve outside the scope of this assessment, then the TEAM TAKE 5 is to be revisited or individual TAKE 5’s are to be completed.

Supervisor - Assigns task with

instruction

If working alone - completion of individual

take 5 (IT5) becomes “Authority to Work”

If working as part of team - conduct team take 5 (TT5) - sign off

by Supervisor becomes “Authority to Work”

Develop or review SWMS with all involved in task

Is there a SWMS required for the Task?

Is a Permit to Work (PTW) Required?

Complete Permit to Work - Supervisor sign off

SAFE TO START

YES

YES

NO

NO

1

2 23

3 24

4

5 25

6 26

7 27

8

9 28

10 29

11

Yes No 30

31

12 32

13

14 33

15 34

16

17 35

18 36

19 37

20 38

39

21 40

22 41

☐ Safety data sheets ☐ Spill kits ☐ SWMS☐ Safe Storage ☐ PPE

Are communica ns suitable for the site? Risk of falls (e.g. working at heights, working from pla orms & ladders, falling objects)

☐ YES ☐ If NO – Contact Supervisor - Complete Step 3 ☐ YES, Complete sec on below

Do work heights exceed 2.0 metres?

Is there a chance that underground services or infrastructure may be contacted during excava n?

☐ YES, permit required - Contact Supervisor ☐SWMS ☐ Dial before you dig ☐ Wanding/Geo Radar

Does the task involve tree removal or the lopping of limbs over and above normal pruning ac vi s?

☐ YES, permit required - Contact Supervisor ☐SWMS ☐ Trained & Authorised ☐ Correct Equipment

☐ Safety barriers ☐ Fences ☐ Signage ☐ Sentry

☐ YES, Complete sec on below


☐ YES, Contact Supervisor - Complete Step 3

☐ Hard hat ☐ Catch ne ng ☐ SWMS☐ Embankment stabilisa on

☐ Team li s ☐ Correct li ing techniques ☐ Mechanical aids ☐ Complete Step 3

☐ Inspected li ing gear ☐ SWMS ☐ Authorisa ons ☐ Complete Step 3

Hazardous materials (e.g. Chemicals, dust, asbestos)

☐ Load restraint guide ☐ Fit for purpose �edowns ☐ If NO – Contact Supervisor

Traffic Management - (vehicle & pedestrian)

Is traffic going to conflict with works or within 3 metres of work gangs/equipment?

☐ TCP required ☐ Speed limits ☐Traffic lights☐ SWMS ☐ Traffic controllers

☐ YES ☐ If NO – Contact Supervisor

Work Environment Hazards (e.g. weather, ground condi ns, confined space, pressure, noise)

Can we come into contact with highly pressurised fluid/gas or air?

Will plant opera ons interact with public ac vi s?

Is equipment parked correctly and securely?


☐ Suitable PPE ☐ Clean area ☐ Suitable equipment ☐ Cut in steps

☐ YES, Contact Supervisor - Complete Step 3 Are there overhead power lines within footprint of job site?


Do any of the ac vi es pertain to road construc n?☐ Construc on Plan ☐ Traffic Management Plan/TGS ☐ SWMS


☐ Pre-start Inspec ns ☐ Out of service tagging ☐ Maintenance Records ☐ No - Contact Supervisor

☐ Pre-start Inspec ns ☐ Out of service tagging ☐ OEM ☐ No - Contact Supervisor☐ Pre-start Inspec ns ☐ Personal Isola n ☐ OEM ☐ No - Contact Supervisor

Are operators aware of isola n requirements and poten al crush/entanglement points?


☐ YES, Contact Supervisor - Complete Step 3 ☐SWMS

☐ YES, Contact Supervisor - Complete Step 3 ☐SWMS Plant Opera ons (Fixed and mobile including tooling and vehicles)

Excava ons (e.g Trenching, foo ngs and earth moving excava ns)

Possible controls

Are all staff aware of the work ac vi s to be performed? Is there the possibility of asbestos or assumed abestos being disturbed?

Do we have required PPE to complete the task?

Do we require a SWMS for task? ☐ YES, Contact Supervisor

Are all workers and/or contractors trained, competent, licensed and fit to perform this task?

Do we have suitable tools and equipment for the task?

☐ Required CHRC Induc ons ☐ Operators licensed & authorised☐ If NO – Contact Supervisor

Are all staff fit for work? (eg. fa gue, drug and alcohol, medica ns etc.)

☐ YES ☐ If NO – Contact Supervisor Are there chemicals/ hazardous substances onsite?

Are loads restrained, covered and NOT overweight for vehicle and within load length, width and height limits?

Is pedestrian control required?

Is your first aid kit, snake bite kit and emergency equipment on site and emergency response prepared? Do ac vi s involve the use of cranage or li ing equipment?

Do any of the ac vi es occur adjacent or over a body of water?

Are weather condi ons causing poten al hazards (e.g. heat, rain, wind etc.)? ☐ YES, Contact Supervisor - Complete Step 3

Will the task require hot works to be undertaken including bitumen works?

☐ YES, Contact Supervisor - Complete Step 3 ☐SWMS ☐ Fire response plan ☐ PPE

Will there be any environmental or cultural heritage impact involved with this task?


☐ Ladder Ispec on ☐ Ladder meets AS Standards ☐ SWMS ☐Working at heights (above 2 metres), permit required - Contact Supervisor

Electrical Hazards (e.g Tooling, services, overhead powerlines)

Is all equipment guarding in place and adequate?

☐ Test & tag ☐ Dry work area ☐ Pre-start inspec n ☐ RCD Tested

☐ Signage ☐ Barricading ☐ No fica ons ☐Traffic Management Plan/TGS

☐ Parkbrake ☐ Wheel Chocks ☐ V Drains ☐ Fundamentally Stable (level ground)

Is all electrical tooling fit for purpose and inspected?

Will we be working near electrical services?

☐ YES, permit required - Contact Supervisor ☐ SWMS

☐ YES, permit required - Contact Supervisor ☐SWMS ☐ Fall arrest/restraint ☐ Work pla orm

Will there be an excava n exceeding 300mm?

Is equipment compliant and fit for purpose? Have all defects been reported?


Does the task require the use of ladders or work pla orm?

Is there a risk of being struck by falling objects?

☐ YES, permit required - Contact Supervisor ☐SWMS ☐ High risk licence ☐ Registers/Plans

Li ing opera ons (e.g. Manual handling, cranage & hoists, slinging of loads)

Yes No Yes No

Item

Do we require any permits to complete task?

Do ac vi s require manual handling?

Safety Prompts Item Hazard Iden fied

Is work being undertaken in a confined space?

Possible Controls



Housekeeping, slippery slopes? Is the site free of trip hazards?


☐ YES, permit required - Contact Supervisor ☐SWMS ☐ Gas monitoring ☐ Rescue plan

☐PPE ☐ Immunisa ons ☐ Sharps containers ☐ Change work method

Will works generate high noise levels/vibra ns?☐ Extra PPE ☐ Sound barriers/baffles☐ Revise work method

Is there a chance of contrac ng diseases whilst carrying out the task?

Are any workers working alone or remotely?☐ YES, Contact Supervisor - Complete Step 3 ☐Procedure

☐ YES, Contact Supervisor

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure☐ Procedure

☐ Procedure

Date:

Yes No

1

2 23

3 24

4

5 25

6 26

7 27

8

9 28

10 29

11

30

31

12 32

13

14 33

15 34

16

17 35

18 36

19 37

20 38

39

21 40

22 41

Item Safety Prompts

☐ YES, Complete section below

☐ Hearing Protection ☐ Limit exposure ☐ SWMS ☐3 point contact



☐ Test & tag ☐ Dry work area ☐ Pre-start inspection ☐ RCD's

☐ Signage ☐ Barricading ☐ Notifications ☐Traffic Management Plan



Will we be working near electrical services

☐ YES, permit required - Contact Supervisor

☐ YES, permit required - Contact Supervisor ☐SWMS ☐ Fall arrest/rest. ☐ work platform

Will there be an excavation exceeding 300mm?

Is equipment compliant and fit for purpose, Have all defects been reported?


Item Hazard Identified

Does the task require the use of ladders or work platform?


Do we require any permits to complete task ?

Possible Controls




Possible controls

Are all staff aware of the work activities to be performed?Is there the possibility of asbestos or assumed abestos being disturbed?

Do we have required PPE to complete task?

Do we require a SWMS for task?



Are all workers and/or contractors trained, competent, licensed and fit to perform this task.


☐ Required CHRC Inductions ☐ Operators licensed & authorised☐ If NO – Contact Supervisor

Are all staff Fit for Work? (eg. fatigue, drug and alcohol, medications etc.) ☐ YES ☐ If NO – Contact Supervisor Are there chemicals/ hazardous substances onsite?

Are loads restrained, covered and NOT overweight for vehicle and within load length, width and height limits?Is pedstrian control required?

Is first aid and emergeny equipment on site and emergency response prepared? Do activities involve the use of cranage or lifting equipment

Do activities require manual handling?


☐PPE ☐ Immunisations ☐ Sharps containers ☐ Change work method

Will works generate high noise levels/vibratons?☐ Extra PPE ☐ Sound barriers/baffles☐ Revise work method

Is there a change of contracting diseases whilst carrying out the task?

Are any workers working alone or remotely?☐ YES, Contact Supervisor - Complete Step 3 ☐ SWMS


Work Environment Hazards (e.g. weather, ground conditions, confined space, pressure, noise)



Will there be any environmental or cutural heritage impact involved with this task?

Are there steep and/or slippery slopes? Is the site free of trip hazards?

Lifting operations (e.g. Manual handling, cranage & hoists, slinging of loads)

☐ Pre-start Inspections ☐ Out of service tagging ☐ OEM ☐ No, Contact supervisor

Are operators aware of isolation requirements and potential crush/entanglement points?





☐ TMR restraint guide ☐ Fit for Purpose tiedowns ☐ If NO – Contact Supervisor

Plant Operations (Fixed and mobile including tooling and vehicles)

Excavations (e.g Trenching, footings and earth moving excavations)

Will Plant operations interact with public activities?




☐ YES, Contact Supervisor - Complete Step 3 Is there overhead power lines within footprint of job site?


Do any of the activities pertain to Road Construction☐ Construction Plan ☐ Traffic Management Plan ☐ SWMS


☐ Pre-start Inspections ☐ Out of service tagging ☐ Maintenance Records ☐ No, contact supervisor


Do any of the activities occur adjacent or over a body of water?

Are weather conditons causing potential hazards (e.g. heat, rain, wind etc.)? ☐ YES, Contact Supervisor - Complete Step 3






Location:



☐ Hard hat ☐ Catch netting ☐ SWMS☐ Embankment stabilisation

☐ Team lifts ☐ Correct lifting techniques ☐ Mechanical aids ☐ Complete step 3

☐ Inspected lifting gear ☐ SWMS ☐ Authorisations ☐ Complete step 3


Team Take 5 - Authority to Work:ksaT:tnemtrapeD



☐ Safety data Sheets ☐ Spill kits ☐ SWMS☐ Safe Storage ☐ PPE

Are communications suitable for the site? Risk of falls (e.g. working at heights, working from platforms & ladders, falling objects)

☐ YES ☐ If NO – Contact Supervisor ☐ YES, Complete section below


Is there chance that underground services or infrastructure may be contacted during excavation?


Does the task involve tree removal or the lopping of limbs over and above normal pruning activities?


Yes No

Stop, step back and think1

Identify hazards2

EXAMPLE01/07/18 Parks & Gardens Remove dead tree from gardens Botanical Gardens

Item

Level of Control (refer to Hierachy of Control table inside

front cover)

Item

42

43

44

45

46

47

Sign

1 6 11

2 7 12

3 8 13

4 9 14

☐ Complete Individual TAKE 5

Team Take 5 - Authority to Work

☐ YES - Sign off and proceed safely

Control


Has the site been le� in safe/clean conditon for public and/or workers?

☐ Housekeeping ☐ Signage☐ Area Barricaded ☐ Other

Control Measure

☐ Revisit Team Take 5 or Complete Individual TAKE 5


Will individuals be working alone on tasks outside the scope of this assessment?

Will individuals tasks change throughout shi�? eg. assigned new task.

Should condi�ons change throughout shi�? e.g weather condi�ons or process change.

Hazard Iden�fiedHazard Iden�fied

SignName

COMPLETION OF JOB/ END OF DAY

Has all required documenta�on been signed off and collected for submission?

Have photographic records been taken of the site?

☐ Photos taken ☐ Video ☐ Sent to Supervisor ☐ Other

NameName

Completed assessments should be filed with job documents for future reference.

Supervisor: Sign: Comment:

(Will the control measures effec�vely manage the hazards, and are they implemented?)

☐ If NO - Contact Supervisor. Further control measures are to be implemented to reduce the risk to as low as reasonably practical (ALARP)

Sign

5 10 15

Are the controls effective?4

Control the hazards3

Date:

Yes No

1

2 23

3 24

4

5 25

6 26

7 27

8

9 28

10 29

11

30

31

12 32

13

14 33

15 34

16

17 35

18 36

19 37

20 38

39

21 40

22 41

Item Safety Prompts



















Possible Controls




Possible controls



















































Location:


















Yes No

Proceed Safely5

EXAMPLENo communications between work team and depot.

Tree requires removing.

4

5

Team to be issued with work mobile phone for the duration of task.

Spotter to have mobile phone with him at all times.

Tree removal permit to be completed and issued.

Level 2

Level 3

Joey South Joey South

P.EAST

Jonathon North

F. W

Peter East

John North

Fred West

Jimmy Bloggs J Bloggs

J.SmithJames Smith

1

2 23

3 24

4

5 25

6 26

7 27

8

9 28

10 29

11

Yes No 30

31

12 32

13

14 33

15 34

16

17 35

18 36

19 37

20 38

39

21 40

22 41

☐ Safety data sheets ☐ Spill kits ☐ SWMS☐ Safe Storage ☐ PPE

Are communica ns suitable for the site? Risk of falls (e.g. working at heights, working from pla orms & ladders, falling objects)

☐ YES ☐ If NO – Contact Supervisor - Complete Step 3 ☐ YES, Complete sec on below


Is there a chance that underground services or infrastructure may be contacted during excava n?


Does the task involve tree removal or the lopping of limbs over and above normal pruning ac vi s?






☐ Hard hat ☐ Catch ne ng ☐ SWMS☐ Embankment stabilisa on

☐ Team li s ☐ Correct li ing techniques ☐ Mechanical aids ☐ Complete Step 3

☐ Inspected li ing gear ☐ SWMS ☐ Authorisa ons ☐ Complete Step 3


☐ Load restraint guide ☐ Fit for purpose �edowns ☐ If NO – Contact Supervisor





Work Environment Hazards (e.g. weather, ground condi ns, confined space, pressure, noise)


Will plant opera ons interact with public ac vi s?




☐ YES, Contact Supervisor - Complete Step 3 Are there overhead power lines within footprint of job site?


Do any of the ac vi es pertain to road construc n?☐ Construc on Plan ☐ Traffic Management Plan/TGS ☐ SWMS


☐ Pre-start Inspec ns ☐ Out of service tagging ☐ Maintenance Records ☐ No - Contact Supervisor

☐ Pre-start Inspec ns ☐ Out of service tagging ☐ OEM ☐ No - Contact Supervisor☐ Pre-start Inspec ns ☐ Personal Isola n ☐ OEM ☐ No - Contact Supervisor

Are operators aware of isola n requirements and poten al crush/entanglement points?



☐ YES, Contact Supervisor - Complete Step 3 ☐SWMS Plant Opera ons (Fixed and mobile including tooling and vehicles)

Excava ons (e.g Trenching, foo ngs and earth moving excava ns)

Possible controls

Are all staff aware of the work ac vi s to be performed? Is there the possibility of asbestos or assumed abestos being disturbed?

Do we have required PPE to complete the task?

Do we require a SWMS for task? ☐ YES, Contact Supervisor

Are all workers and/or contractors trained, competent, licensed and fit to perform this task?


☐ Required CHRC Induc ons ☐ Operators licensed & authorised☐ If NO – Contact Supervisor

Are all staff fit for work? (eg. fa gue, drug and alcohol, medica ns etc.)

☐ YES ☐ If NO – Contact Supervisor Are there chemicals/ hazardous substances onsite?

Are loads restrained, covered and NOT overweight for vehicle and within load length, width and height limits?

Is pedestrian control required?

Is your first aid kit, snake bite kit and emergency equipment on site and emergency response prepared? Do ac vi s involve the use of cranage or li ing equipment?

Do any of the ac vi es occur adjacent or over a body of water?

Are weather condi ons causing poten al hazards (e.g. heat, rain, wind etc.)? ☐ YES, Contact Supervisor - Complete Step 3



Will there be any environmental or cultural heritage impact involved with this task?


☐ Ladder Ispec on ☐ Ladder meets AS Standards ☐ SWMS ☐Working at heights (above 2 metres), permit required - Contact Supervisor



☐ Test & tag ☐ Dry work area ☐ Pre-start inspec n ☐ RCD Tested

☐ Signage ☐ Barricading ☐ No fica ons ☐Traffic Management Plan/TGS



Will we be working near electrical services?

☐ YES, permit required - Contact Supervisor ☐ SWMS

☐ YES, permit required - Contact Supervisor ☐SWMS ☐ Fall arrest/restraint ☐ Work pla orm

Will there be an excava n exceeding 300mm?

Is equipment compliant and fit for purpose? Have all defects been reported?


Does the task require the use of ladders or work pla orm?



Li ing opera ons (e.g. Manual handling, cranage & hoists, slinging of loads)

Yes No Yes No

Item

Do we require any permits to complete task?

Do ac vi s require manual handling?

Safety Prompts Item Hazard Iden fied


Possible Controls



Housekeeping, slippery slopes? Is the site free of trip hazards?



☐PPE ☐ Immunisa ons ☐ Sharps containers ☐ Change work method

Will works generate high noise levels/vibra ns?☐ Extra PPE ☐ Sound barriers/baffles☐ Revise work method

Is there a chance of contrac ng diseases whilst carrying out the task?

Are any workers working alone or remotely?☐ YES, Contact Supervisor - Complete Step 3 ☐Procedure


☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure

☐ Procedure☐ Procedure

☐ Procedure

Date:

Yes No

1

2 23

3 24

4

5 25

6 26

7 27

8

9 28

10 29

11

30

31

12 32

13

14 33

15 34

16

17 35

18 36

19 37

20 38

39

21 40

22 41

Item Safety Prompts



















Possible Controls




Possible controls



















































Location:


















Yes No

Identify hazards2

Stop, step back and think1

Item

Level of Control (refer to Hierachy of Control table inside

front cover)

Item

42

43

44

45

46

47

Sign

1 6 11

2 7 12

3 8 13

4 9 14


Team Take 5 - Authority to Work

☐ YES - Sign off and proceed safely

Control


Has the site been le� in safe/clean conditon for public and/or workers?

☐ Housekeeping ☐ Signage☐ Area Barricaded ☐ Other

Control Measure

☐ Revisit Team Take 5 or Complete Individual TAKE 5


Will individuals be working alone on tasks outside the scope of this assessment?

Will individuals tasks change throughout shi�? eg. assigned new task.

Should condi�ons change throughout shi�? e.g weather condi�ons or process change.

Hazard Iden�fiedHazard Iden�fied

SignName

COMPLETION OF JOB/ END OF DAY

Has all required documenta�on been signed off and collected for submission?

Have photographic records been taken of the site?

☐ Photos taken ☐ Video ☐ Sent to Supervisor ☐ Other

NameName

Completed assessments should be filed with job documents for future reference.

Supervisor: Sign: Comment:

(Will the control measures effec�vely manage the hazards, and are they implemented?)

☐ If NO - Contact Supervisor. Further control measures are to be implemented to reduce the risk to as low as reasonably practical (ALARP)

Sign

5 10 15

Are the controls effective?4

Control the hazards3

Date:

Yes No

1

2 23

3 24

4

5 25

6 26

7 27

8

9 28

10 29

11

30

31

12 32

13

14 33

15 34

16

17 35

18 36

19 37

20 38

39

21 40

22 41

Item Safety Prompts



















Possible Controls




Possible controls



















































Location:


















Yes No

Proceed Safely5

HIGHEST MOST

LOWEST LEAST

LEVEL 1Eliminate the hazards

Substitute the hazard with something safer

Isolate the hazard from people

Reduce the risks through engineering con-trols

Reduce exposure to the hazard using administrative actions

Use personal protective equipment

LEVEL 3

LEVEL 2

Leve

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Rel

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of

con

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sure

s

HIERACHY OF CONTROLHAZARD MANAGEMENT STRATEGY

People Financial Service Delivery / Strategic Objectives

Compliance Reputation and External Stakeholders

Environmental

Insignificant

Incident only, no medical treatment required

Within budget and operational expectations

Negligible impact on delivery of key service

to the community. Unscheduled interruptions

of < 1 day

Negligible statutory or regulatory breach or

compliant, no warning, no penalty.

Negligible adverse impact that can be remedied

immediately.

Negligible environmental or heritage harm

OR

<100K recurrent reduction in Council

budget or <$250K one off loss

Negligible impact on objectives

Negligible legal consequences. Negligible

breach of contract. Resolved by day to day

management

Insignificant public comment or local media

coverage.

Minor

Minor injuries treated by first aid, routine

industrial issues

>$100K-$500K recurrent reduction in Council

budget

Short-term impact on delivery of key service

to the community. Unscheduled

interruptions of 1-3 days.

Minor statutory or regulatory breach, minor

complaint

Adverse impact that is short-term.

Minor environmental or heritage harm within

existing approvals and no compliance impact

OR

$250K-$1M one off loss Minor setbacks that are easily remedied

Potential for litigation with likely favourable outcomes that can be resolved by day to day

management

Heightened concerns from a narrow group of residents, one off

negative media coverage

Moderate

Serious injury requiring medical treatment, staff turnover slightly higher

than 20%, one off industrial issues

>$500K-$1M recurrent reduction in Council

budget

Significant delays to delivery of key service

to the community. Unscheduled interruptions

of 3-14 days.

Statutory or regulatory breach and moderate

fines. Warning or Improvement Notice

issued.

Adverse impact with potential for medium-

term reputational and/ or political damage.

Short term environmental or heritage harm and no

compliance impact

OR

$1M-2,5M one off lossSome of the

organisation’s objectives cannot be met.

Likely litigation with uncertain outcomes. ELT intervention required.

Concerns from cross section of public,

ongoing negative metro media coverage.

Major

Life threatening injury or multiple serious injuries

requiring hospitalisation, fatality, staff turnover

well above 20%, ongoing industrial action

$1M - $10M recurrent reduction in Council

budget or

Extended significant delays to delivery of key

service to the community. Unscheduled interruptions

of 14-30 days.

Serious statutory or regulatory breach with

fines and public exposure

Impacts requiring long-term remedial attention.

Lasting damage to reputation and/or political

standing.

Long term environmental or heritage harm and/ or

non-compliance

OR

$2,5M - $10M one off loss Some important objectives of the

organisation cannot be met.

Litigation with probable negative outcomes.

Contract breach with penalties that cannot be absorbed within current

budget

Significant outcry from public, significant

negative state level media coverage.

Catastrophic

Multiple fatalities, sustained and serious

industrial action, loss of multiple staff at once

>$10M recurrent reduction in Council

budget or >$20M one off loss

Inability to deliver operational functions.

Inability to deliver service to the community.

Significant statutory or regulatory breach

resulting in staff dismissal. Significant adverse judgement

Irreversible political damage to brand and

reputation

Irreparable long term environmental or

heritage harm and compliance sanction

Unscheduled interruptions >30 days.

Most of the organisation’s objectives

cannot be met.

Contract breach with penalties that may result in significant damage to

Council

Significant and widespread public outcry,

sustained negative national media coverage.

RISK CONSEQUENCE TABLE

CODE LIKELIHOOD QUALITATIVE DESCRIPTOR PROBABILITY OF OCCURRENCE

5 Almost CertainIs expected to occur in most circumstances.

Greater than 95%Experience/Data strongly suggests it will happen.

4Likely Will probably occur in most circumstances.

66% to 95%Experience/Data suggests comparable events have occurred

3 Possible Might occur at some time 36% to 65%

2 Unlikely Could occur at some time, improbable under normal conditions. 5% to 35%

1 Rare Unforeseeable or may occur only in exceptional circumstances less than 5%

MEASURES OF LIKELIHOODApproval Date: 30/09/2020Version No: 4

Review Date: 30/09/2025uncontrolled when printed

Excavation Permit FormPage 1 of 2

FORM

Permit - Excavation & Trenching

ECM NO: #890382 DEPARTMENT: Office of the CEO

EFFECTIVE DATE: 1/7/2020 UNIT: Safety and Wellness

This permit is required to be completed in accordance with Council Excavation & Trenching Procedure (ECM #890382): Before commencing any excavation on a brownfield site, or Before excavating to a depth of 300mm or more on a greenfield site, or Where a worker is required to enter an excavation or trench with a depth of 1.5m or more or where there is a risk of

engulfment due to poor ground conditions.

Section 1 - Details of Work

Site name: Date:

Location on site:

Details of work to be undertaken

Permit Open from date & time.

Planned finish date:

Section 2 – Excavation and trenching controls Work environment

Has the relevant SWMS activity been reviewed by all involved in the task? Y ☐ mandatory

Are controls in place to maintain exclusion zones around underground/overhead electrical lines and pole bases, including use of a spotter? If exclusion zones cannot be safely maintained, a ‘Safety Advice’ from the electrical entity is required.

Y ☐ N ☐

Is a spotter to be used at all times during mechanical excavation in brownfield areas? Y ☐ mandatory

Suitable barricade and signs available, at least 900 mm high to prevent unauthorised access? Y ☐ N/A ☐Is there potential for the planned excavation/trench to impact stability of buildings or structures? Y ☐ N/A ☐

Is specialist engineering advice needed to manage risks arising from poor ground conditions or if the depth of the trench exceeds 3m? Y ☐ N/A ☐

Underground Service Location (this section is mandatory before commencing excavation on a brownfield site)

Have all relevant plans, GIS data and drawings been reviewed, including Dial Before You Dig (DBYD PH 1100) and internal Council asset records? Y ☐ mandatory

Has a physical inspection of the planned excavation site and surrounding area been conducted to identify any visual indicators of buried services? Y ☐ mandatory

Have known services with potential to encroach within minimum 3m of the planned excavation have been positively identified and clearly marked via non-destructive methods?(e.g. vacuum excavation, cable locators, ground penetrating radar/technology, hand digging)

Y ☐ N/A ☐

All services encroaching within minimum 300mm of the planned excavation have been visually verified by potholing (vacuum excavation or hand digging). Y ☐ N/A ☐

Has a standby person / spotter been appointed for the task? Y ☐ mandatory

HOLD POINT FOR MECHANICAL EXCAVATION (Mechanical excavation cannot proceed on a Council brownfield site until the Council Supervisor has been consulted to confirm applicable service location requirements have been satisfied.)

Consultation with the Council Supervisor has occurred (record details below). Y ☐

Version: 5, Version Date: 22/02/2021Document Set ID: 1273598

PERMIT TO WORKAsbestos Related Work PermitConfined Space PermitExcavation & Trenching PermitHigh Risk Work Rescue Plan PermitLift Plan PermitTree Felling & Removal PermitWorking at Heights, Roof, Ceiling Space Permit

Permits are to be issued by the supervisor where indicated in the TAKE 5 process

Asbestos Related Work Permits

Supervisors are to ensure that SWMS and procedures are reviewed/developed in conjunction with the permit to work process

Are you safe to start?

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AUTHORITY TO WORK TEAM TAKE 5 ASSESSMENT BOOK

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