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Toolbox Talk/List Minute Risk Assessment Page:
Date : Supervisor/Crew In-charge :
Location : Brief Description of Job :
Project :
Please (✓) the hazards associated Last Minute Risk Assessment
with the activity (based on the
current work conditions) LMRA Check Points (Mark Yes / No) Yes No
Are you aware of the work instruction.
Poor Visibility Manual Handling
Identify the RA and JSA for that work.
Please specify the Ref no:
1. 2. 3. 4.
Confined
Weather Conditions (Communicate the RA and JSA with your crew)
Space
Tools and Equipment
(Inspected and available in good condition)
Slip/Trip/Fall Drop Object
PPE Requirement
(Ensure all the Mandatory PPE required for the Specific activity)
Work at height Radiation
Emergency Response
(known near muster point, First Aid Box, Eyewash Station, Fire Extinguisher)
Electrical Equipment Chemical
Remarks:
Environmental Impact Fire
Please Specify any other hazard If the answer to any of these questions is NO, your safety and your team’s safety are
associated with your activity: at risk. STOP and check again. If it cannot be done safely don’t do it.
Other Points Discussed
Attendees (Record your sign only if all your doubts are addressed by your Supervisor/Foreman)
[Link] Name Designation Sign
6
I confirm, I have conducted LMRA and delievered toolbox talk.
I verify the understanding with the work crew Yes No
Name/Signature: