Staff

CAT7N-5.5P(SS) *

CAT7N-5.5R (R) *

* Indicates required field

Customer Name *

Order Number *

STEP 3: Additional Control Measures Required:

Hazard (Please Number) *

Control (Please Number) *

Risk (Please Number) *

IMPORTANT: Are all hazards suitably controlled and can the job be completed safely? *

Yes No

STEP 4: If all hazards cannot be suitably controlled by this Take 5, then a formal JSA Risk Assessment must be carried out before commencing any work.

Date *

Participant's Names: *

Completed By: *

I agree that all information provided on the Take 5 risk assessment is true and filled out to the best of my ability. *

I agree

Identification Number: *

CES#: *

MISC: *

Completed *

YES NO

Quoted: *

YES NO

Date *

Tradesman Initials & Hours *

Apprentice Initials & Hours *

After Hours *

YES NO

Work Details: *

REMINDER: MISSED MATERIALS = NO INCENTIVE!!

MATERIALS:

Supplier *

Qty *

Part Number *

Description *

Supplier *

Qty *

Part Number *

Description *

Supplier *

Qty *

Part Number *

Description *

Supplier *

Qty *

Part Number *

Description *

Supplier *

Qty *

Part Number *

Description *

Supplier *

Qty *

Part Number *

Description *

Supplier *

Qty *

Part Number *

Description *

Supplier *

Qty *

Part Number *

Description *

Supplier *

Qty *

Part Number *

Description *

Supplier *

Qty *

Part Number *

Description *

S Plugs - Quantities

220S20 *

220S25 *

220S32 *

220S40 *

220S50 *

P to P - Quantities

242/20 *

242/25 *

242/32 *

242/40 *

242/50 *

P to IS - Quantities

258/20 *

258/25 *

258/32 *

258/40 *

258/50 *

P to ExS - Quantities

263/20 *

263/25 *

263/32 *

263/40 *

263/50 *

P Reducers - Quantities

264/1M *

264/2M *

264/3M *

264/4M *

264/5M *

S Reducers - Quantities

264/1SM *

264/2SM *

264/3SM *

264/4SM *

264/5SM *

Nipple - Quantities

243/20 *

243/25 *

243/32 *

243/40 *

243/50 *

Lock Rings - Quantities

259/20 *

259/25 *

259/32 *

259/40 *

259/50 *

Bushes - Quantities

281/20 *

281F20 *

281/25 *

281F25 *

281/32 *

281F32 *

281/40 *

281F40 *

281/50 *

281F50 *

BWIRE - Quantities

BWIRE0.5 *

BWIRE1 *

BWIRE1.5 *

BWIRE1.5FX *

BWIRE2.5 *

BWIRE2.5FX *

BWIRE4 *

BWIRE6 *

BWIRE10 *

BWIRE16 *

CONDUIT - Quantities

9020CM (M) *

9020CHD (M) *

9020MD (L) *

9020HD (L) *

9025CM (M) *

9025CHD (M) *

9025MD (L) *

9025HD (L) *

9032CM (M) *

9032CHD (M) *

9032MD (L) *

9032HD (L) *

9040CM (M) *

9040CHD (M) *

9040MD (L) *

9040HD (L) *

9040CM (M) *

9050MD (L) *

9050HD (L) *

CORRY FIT - Quantities

279C20 *

279AC20 *

279C25 *

279AC25 *

279C32 *

279AC32 *

GAL GUARD - Quantities

GAL32 *

GAL50 *

GAL75 *

GAL100 *

POLE75 *

POLE100 *

WAGOS - Quantities

2 Terminal (870-901) *

3 Terminal (870-681) *

4 Terminal (870-831) *

3 Way Earth (870-687) *

Partition (870-934) *

End Anchor (1492EA35) *

Jumper 2-3 Way (870-402) *

Jumper 4-5 Way (870-404) *

Jumper 10 Way (870-410) *

2/3 Way Connector (222-412/3) *

5 Way Connector (222-415) *

TPS - Quantities

TPS1.5 SDI *

TPS1.5 TWIN *

TPS1.5 T&E *

TPS2.5 SDI *

TPS2.5 TWIN *

TPS2.5 T&E *

TPS4 SDI *

TPS4 T&E *

TPS6 T&E *

SADDLE - Quantities

172GM *

173GM *

174GM *

175GM *

176GM *

180/20 *

180/25 *

180/32 *

180/40 *

180/50 *

280/20 *

280/25 *

280/32 *

280/40 *

280/50 *

GENERAL - Quantities

CABLE TIES MED *

CABLE TIES LGE *

SLEDGER *

GLAND EMC20 *

GLAND EMC25 *

GLAND EMC32 *

GLAND 12 *

GLAND 16 *

GLAND 20 *

GLAND 25 *

GLAND 32 *

GLAND 40 *

GLAND 50 *

JACK CHAIN *

LIGHT FITTING - Quantities

FL136 *

FL236 *

DFL136 *

DFL236 *

PAR 38/1 *

PAR 38/2 *

PAR 38/2S *

30W LED Flood *

50W LED Flood *

LUG SMALL - Quantities

Lug Red *

Lug Blue *

Lug Yellow *

Lug 6mm *

Lug 10mm *

Lug 16mm *

Lug 25mm *

ORANGE CIRC - Quantities

OC1.5 3C *

OC1.5 4C *

OC1.5 5C *

OC2.5 3C *

OC2.5 4C *

OC2.5 5C *

OC4 3C *

OC4 4C *

OC4 5C *

DOMESTIC - Quantities

154 *

155 *

30M *

C2031HA *

C2032HA *

C2033HA *

C2034HA *

C2015 *

C2025 *

C2025XA *

2530LT *

413 *

438 *

439S *

439SHD *

554C4 *

563/1 *

563/2 *

238 *

238A *

449A *

Cable Clips *

WEATHER PROOF - Quantities

WS226 *

WS226/2 *

WSC227 *

WSC227/1 *

WSC227/2 *

WHB120 *

WHB320 *

WHB140 *

WHB340 *

ISO325MY *

DATA - Quantities

Cat5e/6 Cable *

Cat6 Shielded *

Quad Coax *

Crimp Unshielded *

Cat6Crimp Shielded *

Cat5e Shielded *

Cat5e Socket *

Cat6 Socket *

Sboard - Quantities

4CC1S *

4CC1 *

4CC2 *

4CC3 *

4CC4 *

DEKRON - Quantities

DEK0.5 1PR *

DEK0.5 2PR *

DEK0.5 4PR *

DEK0.5 8PR *

DEK1.5 1PR *

BEND/TEE

245/20 *

245/25 *

246/20 *

246/50 *

246/32 *

246/40 *

246/50 *

247/20 *

247/50 *

247/32 *

247/40 *

247/50 *

247L40 *

247L50 *

C/B ABB/NHP - Quantities

DINT1C *

DINT1D *

DINT2C *

DINT2D *

DINT3C *

DINT3D *

RCD's - Quantities

NHP1P *

NHP2P *

CLI/ABB1P *

CLI/ABB2P *

MESH - Quantities

SPLICE BOLT *

SIDE JOINER *

150MESH *

150TRAPEZE *

150CANTER LEVER *

300MESH *

300TRAPEZE *

300CANTER LEVER *

450MESH *

450TRAPEZE *

450CANTER LEVER *

600MESH *

600TRAPEZE *

600CANTER LEVER *

Enclosure & Base - Quantities

ISL0846A00 *

ISL0850A00 *

ISL0854A00 *

ISL0856A00 *

ISL0858A00 *

ISL0860A00 *

ISL0862A00 *

ISL0864A00 *

PVC FLEX - Quantities

FC.5 2C *

FC.75 2C *

FC.75 3C *

FC.75 4C *

FC.75 5C *

FC1 2C *

FC1 3C *

FC1 4C *

FC1 5C *

FC1.5 2C *

FC1.5 3C *

FC1.5 4C *

FC1.5 5C *

FC2.5 3C *

FC2.5 4C *

FC2.5 5C *

NHP 22mm - Quantities

D7-ALP (latch) *

D7-X01 (nc) *

D7-X10 (no) *

Push Buttons - Quantities

START/STOP *

D7P-FP inc Cap *

Switches - Quantities

D7P-S_22 (2P) *

D7P-S_32 (3P) *

E/Stops - Quantities

D7P-MT44 *

D7P-X01S *

D7-15YE112 *

Push Button Enclosures - Quantities

D71YM *

D71PM *

D72PM *

D73PM *

J BOXES - Quantities

240/20/1 *

240/20/2 *

240/20/3 *

240/20/4 *

240/25/1 *

240/25/2 *

240/25/3 *

T240/4H/20 *

T240/4H/25 *

HEATSHRINK - Quantities

Sml - 5mm *

Earth - 5mm *

Med - 10mm *

Earth - 10mm *

Lrg - 20mm *

Earth - 20mm *

XL - 40mm *

Resin - 12/3 *

Resin - 22/6 *

Resin - 40/12 *

Resin - 55/16 *

CONTACTORS - Quantities

CA7-12 *

CA7-16 *

CA7-23 *

CA7-30 *

CA7-37 *

Coil - Quantities

TA 24-480V *

TC 24-480V *

Overload Small - Quantities

CEP7-EEBB 0.2-1 *

CEP7-EECB 1-5 *

CEP7-EEEB 5.4-27 *

Overload Large - Quantities

CEP7-EESB 5.4-27 *

CEP7-EEFD 9-45 *

Overload Single - Quantities

CEP7S-EESB 5.4-27 *

CEP7S-EETD 9-45 *

Contactor Enclosures - Quantities

CAT7N-5.5P (SS) *

CAT7N5.5R (R) *

RELAY - Quantities

G2R-1-SNI DC12 *

G2R-1-SNI AC24 *

G2R-1-SNI AC240 *

G2R-SNI DC12 *

G2R-2-SNI DC24 *

G2R-2-SNI AC24 *

G2R-2-SNI AC240 *

P2RF-05-E *

P2RF-08-E *

Timers - Quantities

H3 DK-S2 *

H2DK-M1 *

H3DS-ML *

H3CR-A 24v *

H3CR-A 240v *

H3CR-A8 24v *

H3CR-A8 240v *

Y92F-30 *

P2CF-08 *

P2CF-11 *

56 Series - Quantities *Add RO for Orange

56C410 *

56C420 *

56C432 *

56C510 *

56C520 *

56C532 *

56P410 *

56P420 *

56P432 *

56P510 *

56P520 *

56P532 *

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