Tool Box Talk Recording Form

• Site conducted / Location
  Address

• Conducted on

  Date

• Delivered by

• Number of personnel present

• Subject being discussed

• Please detail below the areas/subjects discussed.

• Did all those present show a good level on interest and attention to the session?

  Yes

  No

  N/A

Names and Signatures of all person present during session

• 1. I have read/had explained to me, the above Health and Safety communication, and I fully understand the processes,
  2. I have asked any questions to clarify anything I do not understand.
  3. I acknowledge and understand that it is MY responsibility to follow all procedures in a safe and responsible manner, to
  report any safety issues identified to my supervisor immediately, and to cease work until the issue is rectified, and/or, I am
  authorised to continue working.
  4. Failure to comply with the processes and procedures as set down by GTR, may result in disciplinary proceedings.

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign

Name and Signature of Person delivering the tool box talk

• Signature

  Sign

• Date and time

  Date
• Location
  Address