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Remember you are responsible for your safety and that

of the others, know the hazards, use the right tool, wear

the right PPE and comply with all the HSE requirements.

Section 4 Section 2 Section 1

Hazard /Risk Management Hazard /Risk Identification

Can all personnel in the group answer YES to the

following questions? If yes, Tick the box

Will the work involve any of the following?

If the answer to any of these questions is NO, then

the hazards must be re-assessed in section 3

The supervisor should confirm the understanding

of the group by asking open questions on the above

points

AT THE END OF EACH WORKING SHIFT, THE WORK AREA MUST BE LEFT IN A CLEAN AND TIDY MANNER

If yes, the work may be hazardous and care

should be taken to ensure the work is done

safely

Toolbox MeetingRiskIdentificationCardFacility/Project:.

Location:.

Task:

Date/Time:..

PTWNo:

Attendee: member of work party

Names/Signature

1 -------------------------- 11 --------------------------

2 -------------------------- 12 --------------------------

3 -------------------------- 13 --------------------------

4 -------------------------- 14 --------------------------

5 -------------------------- 15 --------------------------

6 -------------------------- 16 --------------------------

7 -------------------------- 17 --------------------------

8 -------------------------- 18 --------------------------

9 -------------------------- 19 --------------------------

10 -------------------------- 20 --------------------------

Are all the steps required to carry out each task in today's activity reviewed in

the TBM risk assessment, (the TBM Task hazard analysis)?

Are all the hazards identified in each step included in the SECTION 3 of

this JHA-TBM form?

Have control measures been identified for each hazard?

Are action parties for implementing each control measures identified, andALL the controls in place?

Are the appropriate HSE tools/equipment available, adequate, functional and

in the right place?

Have all the work party received the required trainings, and are wearing

appropriate PPE for the tasks to be performed?

Are all the relevant procedures, permits, etc communicated to and understood

by the work party?

Have the other people on this site, adjacent and/or impacting sites been

informed of this job and the content of the permit?.

Are all the work party aware that any changes in the work plan should be

communicated to everyone involved in the work?

Is the work party aware of the emergency measures and equipment locations,

such as egress, alarms, portable fire fighting equipment and spill kits?

Is the worksite clean, tidy and in a manner fit to commence the work activity

and is time allowed for cleaning after the days work?

Is the work site safe to start work, all isolations confirmed, Gas test done and

warning signs in place?

Have all isolations been identified, implemented and checked by supervisor

and workparty, if applicable?

Have all working at height and confined space risks, access /egress route

been addressed??

Y NUse of lifting equipment. If yes is the lifting plan developed and available

on site?

Has the lifting plan been read and understood by the lifting party

Manual handling - moving or carrying objects/tools with significant risk

of injury? if yes, is the manual handling assessment done?

Working with or near an object/equipment that may move or potentially

dangerous (e.g rotating part, live plant)

Working in a confine space

Working in an area with poor visibility (lighting or tight) or weather

Working in an area where personnel can trip, slip or fall

Working with equipment or connections under pressure

Personnel who are new (to the operation/team) or yet to undergone the

required trainings

Potential for in/flammable liquid and/or gas (e.g Crude oil, fuel,

condensate)

Potential for environmental impact (Spill, waste, emission) peculiarto the job location

Concurrent operations and potential conflict with adjacent work places

or work parties

Potential Hazards from Energy sources:

Motion Energy Sources

Chemical Energy Sources (incl. dangerous goods or substances hazardous

to health/environment)

Radiation Energy Sources

Electrical Energy Sources (Static or current)

Pressure Energy Sources

Biological Energy Sources

Heat/Cold Energy Sources

Gravity Energy Sources - (Incl. dropped objects, working

at height or over side)

Y N

Are past incidents, including HIRs, nearmisses and Learning from

incidents (LFIs) related to this job discussed and applicable learning

understood?

Names/Signature

TBM Leader:____________________________

Reviewed by:

Permit Holder : ___________________and/or

Contractor Supervisor : _________________Asset Holder Site Supervisor:_____________

Action required:

Update Work method statement: Yes/No ___

Update Plans/Procedures/JHA:Yes/No _____

Feedback/Others: _____________________

______________________________________

______________________________________

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Remember sources of energy : Motion, Chemical, Radiation, Electrical, Gravity, Heat/Cold, Biological, Pressure

Tool Box Meeting Task Hazard Analysis(This section should be used to summarise the key points of the relevant risks identified during the teams discussion)

Task to be carried out:(The task should be a part/section of the job planned for the day)

Section 3

Controls Responsible Person

To take Action

Step 1:

Hazard/Threat

Step 8:

Step 2:

Step 9:

Step 3:

Step 5:

Step 6:

Step 7:

Task Breakdown

Step 4:

Step 10:

(Review each step to find out what could go wrong?) (How can the hazard be prevented from being released?)Controls in Place

Yes No

Know your Emergency Response procedure, Emergency Telephone number ______________, and the Location of nearest Telephone:________________

*IN THE EVENT OF AN ACCIDENT: STOP THE JOB, INFORM YOUR SUPERVISOR, CONTACT CSR/MEDIC, GIVE 1 ST AID IF REQUIRED*

(Break the tasks into basic steps, use active verbs)