Worksite Check and Toolbox Talk by Person In Charge

1. Details (all fields must be completed)

Person In Charge (Name) Person In Charge Mobile # PTW Number Company / Department Signature Date & Time of Tool Box Talk Number of Persons in the Workgroup (Including PIC) Number of Visitor

2. Worksite Check
The Person In Charge must check before the commencement of work that the following resources are available on site to complete the works. No. Requirement Yes No NA Remarks

Workgroup
1 2 3 Adequate number of competent personnel to complete the works Personnel have appropriate certification to demonstrate their competence to undertake the required works Personnel appear fit for duty and not under the influence of alcohol, drugs or fatigue Personal Protection Equipment (PPE) appropriate to the works Tools, equipment and materials Voltage detector (for lineside) Third Rail Earthing Device (TRED) (for lineside) Worksite marker boards (for lineside)

Tools and Equipment (you must check for adequate type, quantities available and working condition) Where applicable
4 5 6 7 8

Briefing of Notices (you must list the applicable Notices that were briefed out) Where applicable
9 Notices briefed to the workgroup

3. Tool Box Talk This Tool Box Talk is conducted to brief the method of statement as well establishing and managing a safe system of work on Dubai Metro controlled premises.
No. 1 2 3 4 5 Requirement Scope of Work Time duration to complete the work Location of the Work Worksite Limits Access and Egress routes to and from worksite Access Egress Details

Serco Dubai Metro Worksite Check and Toolbox Talk by Person In Charge

1/2 Serco Internal

Date: 10/09/2013 DM001-BPP-ALL-FO-01076 A2

Worksite Check and Toolbox Talk by Person In Charge

No. 6 7 Requirement Hazard at worksite Safe System of work Including protection measures Assigned Roles and duties of personnel on site (Eg. Fire watch in case of Safety permit Hot work, Lookouts in case of Lineside area, etc) Position of Safety (Where appropriate) Communication arrangements Emergency arrangements Others Note the detail of the Late joiner / early leaver from the Worksite. Details

9 10 11

12

4. Declaration By signing this I hereby acknowledge that I am aware of and I understood the topic/s discussed above.
Workgroup (For Lineside Activity All work group must be lineside work Trained) Name of Person Signature No. Name of Person

No.

Signature

No.

Visitors (Not allowed to work Maximum Allowed Visitors: 6 Person) Name of Person Signature No. Name of Person

Signature

Serco Dubai Metro Worksite Check and Toolbox Talk by Person In Charge

2/2 Serco Internal

Date: 10/09/2013 DM001-BPP-ALL-FO-01076 A2