STOP & Take 5

Pre-Task Risk Assessment

Before starting ANY task: STOP what you're doing and take 5 minutes to identify hazards and controls. If you can't control the hazards, STOP THE WORK.

Your Name *

Date *

Time *

District / Base *

Specific Work Area *

Task Description *

Task Type *

🛑 S.T.O.P. - Have You...

Stopped to assess the situation?

Pause before starting. Look around. What's happening in your work area?

Thought through the task?

Consider all steps. What could go wrong? Do you have the right tools and training?

Organized your work area?

Is housekeeping adequate? Are tools staged properly? Clear path to exit?

Proceeded safely?

Are you ready to perform the task safely? If not, STOP and get help.

⚡ Energy Sources Present

Select ALL energy sources that will be present during this task.

⬇️GravityFalls, Drops

🔄MotionVehicles, Moving

⚙️MechanicalRotating, Pinch

⚡ElectricalShock, Arc

💨PressureHydraulic, Gas

🧪ChemicalToxic, Flammable

🌡️TemperatureBurns, Cold

🔋StoredSprings, Tension

☢️RadiationIonizing, UV

🦠BiologicalPathogens

🔊SoundNoise, Vibration

🏋️ErgonomicRepetitive

🛡️ Controls You Will Use

Select the controls you will have in place for this task.

TIER 1Direct Controls (Most Effective)

These physically remove or isolate the hazard

Elimination

Substitution

Engineering

TIER 2Indirect Controls (Moderate)

These separate people from hazards or provide warnings

Guarding

LOTO

Warnings

TIER 3Administrative/PPE (Least Effective)

These rely on human behavior to be effective

Administrative

PPE

⚠️ Take 5 - Identify Up to 5 Hazards

Hazard #1

Hazard Category

Control Measure

Hazard Description

Hazard #2

Hazard Category

Control Measure

Hazard Description

Hazard #3

Hazard Category

Control Measure

Hazard Description

Hazard #4

Hazard Category

Control Measure

Hazard Description

Hazard #5

Hazard Category

Control Measure

Hazard Description

📊 Risk Assessment

Initial Risk Level (Before Controls) *

LOW

Minimal risk

MEDIUM

Some risk

HIGH

Significant risk

CRITICAL

Extreme risk

Residual Risk Level (After Controls) *

LOW

Minimal risk

MEDIUM

Some risk

HIGH

Significant risk

CRITICAL

Extreme risk

Is it Safe to Proceed? *

✅ Yes - Safe to Proceed

🛑 No - STOP WORK

Additional Controls or Comments

Supervisor Notified? *

Yes

N/A

AnthroSafe™ Field Driven Safety