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May. 29, 2013 • 9 likes • 23,845 views

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 13 toolbox meeting form

1. 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: Permit Type: IA Name: 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 ʻStop Workʼ 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 a ect 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.
2. 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 le 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

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