DATE:

LIFE SAVING TALK Control no.:

JOB DESCRIPTION: LOCATION:

WORKER'S SUPERVISOR: SITE JOB SUPERVISOR:
NOTE: KEY REQUIREMENTS OF INSULATIONS AND PERMITS MUST BE DOCUMENTED BELOW BY THE WORKER'S SUPERVISOR
WHAT COULD SERIUOSLY INJURED WHAT WILL WE DO TO PREVENT IT FROM DIAGRAM OR FURTHER
WHO WILL DO IT?
PEOPLE OR DAMAGE THE EQUIPMENT? HAPPENING? EXPLANATION

NOTE: ALL WORKERS MUST SIGN THIS FORM TO INDICATE THEY UNDERSTAND IT AND WILL APPLY ITS REQUIREMENTS FOR THE DURATION OF
THE JOB.
Beside signatures, record trade used for his job: WELDER (W), CLEANER ©, HELPER (H), ELECTRICIAN €, MECHANIC(M), SUPERVISOR (SUP).
NAME AND SIGNATURE NAME AND SIGNATURE NAME AND SIGNATURE NAME AND SIGNATURE

RECORD OF JOB TALKS / INSPECTIONS

DATE TIME SUPERVISOR SIGNATURE CHANGES TO JOB OR COMMENTS