Toolbox Talk Form

The objective of this form is to provide a tool to be used to perform an effective

toolbox talk before start of all activities performed on an asset operated by Petrofac.

This form is to be used by the Performing Authority and signed off by all members
of the Work Party.

It should be used in the context of the Control of Work, as further defined in the IES
Control of Work Standard (IES_COR_AE_X_002), as illustrated in the figure below.

Life-Saving
Rules

What a good Toolbox Talk looks like:

• Perform the Toolbox Talk on the job site if possible
• Perform the Toolbox Talk just before the job starts
• Have all the paper work ready
• Have everybody involved in the job present for the Toolbox Talk
• Invite additional people if required
• Show Energy – speak loud, show interest
• Create an open discussion – ask open questions, ensure it is a two way conversation
• Go through the tasks
• Discuss related risks and what could go wrong
• Clear all doubts from the team
• Get commitment
• Ensure everybody sign the form in person

Rev 01 ©Petrofac Facilities Management Limited 2015

 CCR: MEDIC: PtW:
IMPORTANT Nos.
RADIO FRQ/CHL: TANNOY: ICC:

Task description:

Installation name:

Date: Time:

Toolbox Talk delivered by:

Did anything happen during the previous shift that should be discussed prior to starting work?

If you identify a significant hazard not covered within the permit STOP THE JOB NOW and contact the Area Authority (AA) to discuss.
Additional controls may be entered below and validated by the AA.

ADDITIONAL HAZARDS IDENTIFIED

Hazard Specific control AA verified

Talk leader prompts Human factor prompts Life-Saving Rules (LSR)

These questions should be directed at Can human factors affect your task? Categories to be considered (Score out those that
relevant personnel to confirm understanding of Have you considered the following: do not apply)
the task hazard:
• fatigue including lack of sleep Hot Work
• what energy sources could be released or Bypassing Safety
• communications
contacted during this job? Controls
• personal factors
• what are your responsibilities for implementing Line of
• physical condition (pain/discomfort) Confined
the control measures? Fire
• understanding of procedures and instructions Space
• what might go wrong with this job?
• capabilities/experience Safe Mechanical
• how will you be communicating with
the team? • stress Driving Lifting
• what do we do if we see changes to the work • ergonomics
plan arising? • new starts to the asset/team Working at
• is everyone familiar with and know how to use Energy Height
tools and equipment safely? Isolation
• are we ready to start the job? Work
Authorisation

Dynamic risk review/stop the job Simultaneous operations Time out for safety (TOFS)

As the job progresses, conditions change (Think about location, environment, timing, etc) Reason for TOFS:
and the hazards, risks and controls should
be reassessed.
As a minimum, we will reassess the job at the
following stages:

1. Actions taken:

2.

3.

4.

Rev 01 ©Petrofac Facilities Management Limited 2015

 Work party declaration

Names and signature of persons involved in job. AA. Name AA. Signature
• the AA (or designate) has visited the worksite
• the IA has visited the worksite with the IA. Name IA. Signature
work party to prove Isolation Integrity
• I have participated in the Toolbox Talk
1. Name 1. Signature
• I know the hazards involved and controls
required to make the job safe
2. Name 2. Signature
• I have read and will follow the relevant
procedures 3. Name 3. Signature
• I will stop the job if unsafe or if I observe any
of our agreed stop the job triggers 4. Name 4. Signature

5. Name 5. Signature

6. Name 6. Signature

7. Name 7. Signature

8. Name 8. Signature

All new persons joining the work party to be Persons new to task:
given a thorough handover and make reference
to this form.
1. 3.

2. 4.

Post job review – what lessons have been learned during this job?

LESSONS LEARNED

Incidents or near misses during task? Yes/No (delete as appropriate)

Summary of incident/near miss:

Update procedure(s): Update risk assessment(s):

Companies/people to be informed/consulted: Yes/No – Identify who:

Supervisor sign-off

TO BE COMPLETED BY THE SUPERVISOR

Position: Date: Was active monitoring carried out on this task? Yes/No

Name: Signature: Have all lessons learned been logged? Yes/No

Rev 01 ©Petrofac Facilities Management Limited 2015