Template

Take 5 Safety and Environment Checklist

by Mark Franke, from the Community

20+

This Take 5 safety and environment checklist helps workers pause before starting a job to identify hazards, confirm permit-to-work requirements, and plan controls. It guides users to stop and think through the task, review training, tools, PPE, and documentation, consider common hazards (slips, falls, energy sources, chemicals, mobile plant, environmental impacts), assess risk, and implement changes before proceeding. It supports JSEA and permit decisions and is suitable for industrial and manufacturing sites. Adapt to your operations and local regulations before use.

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Terratree Stop-Take 5 Checklist
Terratree Stop-Take 5 is a pre-task risk assessment checklist that helps workers pause, think, and identify hazards before starting work. It guides users through STOPS, THINK, IDENTIFY, PLAN, and PROCEED, checking JHA alignment, immediate hazards, communication with other work groups, required permits, correct tools and equipment, and isolation or lockout steps. Capture hazards and controls, then sign off to confirm controls are in place before proceeding.
by Josh Page, from the Community
Downloads: 0
Get
Template
MAD3 Engineering Take 5 Safety Form
This Take 5 Safety Form by MAD3 Engineering guides workers to pause and think before starting a task. It captures job details and prompts users to confirm understanding of the task and procedure, check that tools are correct and in good condition, and verify required PPE. The form helps identify hazards including manual handling, slips, trips and falls, mechanical and moving parts, moving plant and roads, and multiple energy sources such as electricity, water, hydraulic, gas, chemical, steam and gravity. It also considers environmental and structural hazards, chemicals, biological risks, radiation, asbestos and dangerous animals. A risk matrix supports assessment, with clear stop work guidance when risk is high. The checklist then focuses on managing changes, ensuring hazards are eliminated or controlled and that PPE, site induction and sign in are complete before proceeding, followed by a signature to authorize work.
by Nathan Jansen van Doorn, from the Community
Downloads: 20+
Get
Template
STOP TAKE-5 Safety Checklist
This STOP TAKE-5 safety checklist helps workers pause before starting a task to identify hazards, evaluate likelihood and consequence, set raw and residual risk ratings, and implement controls. Use it to verify permits, PPE, and equipment condition, document hazard removal, and discuss potential issues, then confirm the job can proceed safely. Fully customizable and suitable for field teams across construction, maintenance, and operations.
by Mandy Grieve, from the Community
Downloads: 40+
Get
Template
P and O Take 5
Use this P and O Take 5 checklist to stop and think before starting work on vessels or maritime sites. Capture task details, verify permits and approvals, check equipment condition, and review common hazards including slips, trips and falls, overexertion, caught in risks, and falling objects. Record additional hazards and controls, confirm controls are sufficient, and sign off operator readiness before proceeding.
by Andre Persad, from the Community
Downloads: 20+
Get

Take 5 Safety and Environment Checklist

About author

You might also like

Terratree Stop-Take 5 Checklist

MAD3 Engineering Take 5 Safety Form

STOP TAKE-5 Safety Checklist

P and O Take 5

You might also like

Terratree Stop-Take 5 Checklist

MAD3 Engineering Take 5 Safety Form

STOP TAKE-5 Safety Checklist

P and O Take 5