🛑 STOP & TAKE 5

Risk Assessment

SLP Alaska Safety Management System

1STOP

2THINK

3OBSERVE

4PLAN

5PROCEED

📋 Basic Information

Your Name *

Date *

Client/Company *

Location *

Task/Job Description *

⚡ Energy Wheel - Identify High Energy Sources

⚡ What ENERGY TYPES are present in this task?

Select all energy sources that could cause serious injury if released uncontrolled.

⬇️Gravity
Falls, drops, collapse

🚗Motion
Vehicles, moving equipment

⚙️Mechanical
Rotating, pinch points

⚡Electrical
Shock, arc flash

💨Pressure
Hydraulic, pneumatic, gas

☠️Chemical
Toxic, corrosive, flammable

🔥Temperature
Burns, cold exposure

🔋Stored Energy
Springs, capacitors

🛡️ What CONTROL TYPES will be used?

Select controls in place to manage identified energy sources.

🚫 Elimination

🔄 Substitution

🔧 Engineering

🚧 Guarding

🔒 LOTO/Isolation

⚠️ Warnings/Signs

📋 Procedures

🦺 PPE

⚠️ Step 1-3: Identify Hazards

Describe the Hazards *

Describe the Risks *

🛡️ Step 4: Plan Controls

Describe the Controls *

📊 Risk Assessment

Severity / Consequence *

Probability *

Risk Level Result

Select severity and probability to calculate risk level

✅ Step 5: Decision to Proceed

Is it safe to proceed with the task? *

✅ Yes - Safe to Proceed⚠️ Conditional - With Controls🛑 No - Stop Work

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