13 toolbox meeting form

Daily Toolbox Meeting Form
Job Name & Description (Define Scope of Work for the day): Document Control No:
(TB-Date-Initials)
TB-
Employee Leading the Toolbox: Name of AA / Project Oversight:
Jack Oman (BP) / Chuck Zimmerman (BC)
Date:
Pre-Start Review:
Risk Assessment:
Does an SOP exist for the job? Yes No SOP#: If NO, the TSEA is substitute SOP
Job Level risk assessment complete? Yes No RA #:
Task Level risk assessment complete? Yes No TSEA#:
Have RAs and TSEAs been reviewed and validated on site by workforce members?............................................... Yes No
Have newly identified risks been documented on TSEA? ………………………………………………………………… Yes No NA
Has a member of the workforce conducting each task participated in the TSEA review? ……………………………. Yes No
Have all members of the workforce confirmed understanding of the work scope, hazards, and risk controls? …….. Yes No
Has everyone reviewed the Emergency Response Plan? ………………………………………………………………… Yes No
Have equipment checks been completed, documented and reviewed? …………………………………………………. Yes No NA
SIMOPS or Multi-Crew Activity?:
Yes No Describe:
Management of Change (MoC):
Does the work activity require an MoC? Yes No Describe:
If YES, has the MoC been authorized by BP management? Yes No (If NO, Stop Work and consult BP management)
Work Permits:
Identify any permitted activities: Permit # No Permits Issued
Permit Type: IA Name:
Daily Safety Discussion:
Topics Discussed:
Will any conditions change the muster point for today? Yes No Where?
Acknowledgements
By signing you are stating the following:
I know the hazards:
1. You have been involved in the Task
Safety Environmental Analysis and
understand the hazards and risk
control actions associated with each
task you are about to perform.
2. You understand the permit to work
requirements applicable to the work
you are about to perform (ifit
includes permitted activities).
3. You are aware that no tasks or work
(that is not risk-assessed) is to be
performed.
4. You also are aware of your obligation
to ‘Stop Work’
I arrived and departed fit for duty:
5. You are physically and mentally fit
for duty.
6. You are not under the influence of
any type of medication, drugs or
alcohol that could affect your ability
to work safely.
7. You are aware of your responsibility to
bring any illness, injury (regardless of
where or when it occurred) or fatigue
issue you may have to the attention
of the Work Crew Leader.
8. You signed out uninjured unless you
have otherwise informed the Work
Crew Leader.
STOP WORK:
I will STOP the job any time anyone is
concerned or uncertain about safety.
I will STOP the job if anyone identifies
a hazard or additional mitigation not
recorded on the TSEA.
I will be alert to any changes in personnel,
conditions at the work site or hazards not
covered by the original TSEA.
If it is necessary to STOP THE JOB, I will
reassess the task, hazards and mitigations; and
then amend the TSEA as needed.

Daily Toolbox Meeting Form
End-of Day Review:
Were there any Incidents, Injuries or First-Aid Reports for the day?:
Yes No Describe:
Were there any STOP WORK interventions?:
Yes No Describe:
Were any areas for improvement identified?:
Yes No Describe:
At the conclusion of the day, I certify that the job site is being left in a safe condition and there were no unreported incidents or first aid:
Signature of Work Crew Leader:
Workers
Name/Signature Company Fit Time in Fit Time out
Visitors
(Names of Site visitors not involved in the work activities)
Name Company Time in Time out

13 toolbox meeting form

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13 toolbox meeting form