SA-M-02-03-02 STOP!

Take 5 Template
PREPARED BY APPROVED BY APPROVAL DATE DOCUMENT KIND
Alex Masotti Martin Schuchmann 2021-03-16 Form
STATUS SECURITY LEVEL DOCUMENT ID. REV. LANG. PAGE
Approved Internal 8DAA5005251 A en 1/2
© Hitachi ABB Power Grids 2020. All rights reserved.

Stop! Take 5
Name: Signature:
Date and time: Area/ site/ workshop:
Task description:
ABRA reference #:

Yes No
1. STOP and think before we act!
Is the ABRA, HSE Plan, work scope and/or safe working procedure available and
understood?
Have all required permits to work been obtained?
Has our manager/ supervisor authorized us to perform the activity or operate the
equipment?
2. Are we COMPETENT and SKILLED to do the job?
Does everyone have all the right qualifications and evidence to prove competence?

Are we trained, competent (certified) to conduct this task?

Have we done this task before?

3. Are we properly EQUIPPED?

Are the tools inspected, certified and suitable for the job?

Are the resources (equipment, PPE and personnel) available ?

4. LOOK and see the RISKS around you.

Have we identified and controlled all risks, including those listed in the ABRA?

Are all persons (e.g. contractors) protected from our activities in the area?
Do we know what to do in case of an emergency?
Do you have safe access/ egress to and from the work area?
Is the work area clean and tidy?
Are you compliant with the PG Life Saving Rules?

5. Are we OK to start the activity?

Can we perform the job as planned in the ABRA?

Are all persons potentially affected aware of the work activities?

If you answered NO to any of these questions,

consult your Line Manager and HSE Support
for assistance.

HITACHI ABB POWER GRIDS

 SA -M -0 2 -0 3 -02 STO P! TA KE 5 TE MP LATE

STATUS SECURITY LEVEL DOCUMENT ID. REV. LANG. PAGE

Approved Internal 8DAA5005251 A en 2/2
© Hitachi ABB Power Grids 2020. All rights reserved.

Actions taken to address newly identified risks

Residual
Risks: How can we get hurt? Controls: What can we do about it?
Risk Level
List risks you may encounter doing your List control measures implemented to L, M, H *
job not identified on the ABRA mitigate the risks

* Low, Medium, High

If remaining risk levels are higher than ABRA, job must not start until ABRA is reviewed.
All clear - perform your job safely!
All personnel understand the potential hazards and agree proper controls are in place.

Participants (names and signatures)

All high-risk activities MUST be performed according to the Life Saving Rules.