PT.

International Recovery Services Indonesia Phone: +62-21-726-3010

Jl. Cikatomas I 25, KebayoranBaru, Jakarta Fax: +62-21-726-3011
Selatan, 12180 Email: Jakarta@international-recovery.com

TOOLBOX SAFETY MEETING FORM

Job No: Project:
Site: IRS Site Manager:
Date: Time:

Subject Details Client/ IRS Covered?

Procedures
Site Layout and Explain layout and any hazards that exist Client
Hazards
Emergency Explain emergency procedures, including Client
Evacuation marshalling points and exit routes from
Procedures worksite
JSA Explain findings of JSA to team and all of IRS
the site & environmental hazards and
precautions that must be observed
Work Areas Show location of work areas Client
Safety Requirements Reinforce requirements to work in Client& IRS
accordance with Workcover guidelines,
wear all required PPE and take all necessary
precautions
Incident Reporting All incidents and near misses are to be IRS
reported to supervisor and logged in site
accident log
Tools, Plant & All electrical equipment must be tagged & IRS
Equipment in date, any out of date tags or equipment
that appears unsafe needs to reported to
supervisor
Worksite Worksite is to be kept clean & tidy, rubbish IRS
Housekeeping is to be properly disposed of, proper
warning signs are to be displayed
Hazardous Proper management of all hazardous IRS
Substances substances is required at all times,
including taking all safety precautions as
per MSDS sheets
First Aid Facilities Indicate location of first aid facilities and Client& IRS
First Aid Officer
Site Traffic Follow any site traffic regulations, only park Client
Regulations in authorized areas
Uniform Proper uniform must be worn at all times IRS
on site
Security and sign on All team members must sign in and out Client
each day and get permission from security
to access worksite if required
 PT. International Recovery Services Indonesia Phone: +62-21-726-3010
Jl. Cikatomas I 25, KebayoranBaru, Jakarta Fax: +62-21-726-3011
Selatan, 12180 Email: Jakarta@international-recovery.com

TOOLBOX SAFETY MEETING FORM

Follow-up actions: Person in Charge Deadline
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I Agree & Understand the resolutions made in meeting & will follow them
1. Name: Signature:
2. Name: Signature:
3. Name: Signature:
4. Name: Signature:
6. Name: Signature:
7. Name: Signature:
8. Name: Signature:
9. Name: Signature:
10. Name: Signature: