JR Toolbox/Safety Meeting Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel in attendance

• SUPERINTENDENT NAME:

• PROJECT MANAGER NAME:

• FOREMAN:

TOPICS COVERED

• TOPIC #1

• Add media

  Media

• TOPIC #2

• Add media

  Media

• TOPIC #3

• Add media

  Media

• TOPIC #4

• Add media

  Media

• TOPIC #5

• Add media

  Media

• Did you check the following? Protection for...Eye/Face? Head? Foot? Hand? Respiratory? Hearing?

  Yes

  No

  N/A

• Proper...Fall protection? Equipment? Scaffolding? Extension cords? Power Source? GFCI? Housekeeping?

  Safe

  At Risk

  N/A

EMPLOYEE SIGN IN

• Name:

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• Date and time of meeting

  Date

• Meeting Facilitator:

  Sign