005 RMS Surveillance Checklist H5 VEHICLE MOVEMENT ON SITE

• H5 VEHICLE MOVEMENT ON SITE .

• Project Name: Tabulam New Bridge.

• Location: BRUXNER HIGHWAY TABULAM

• Contractor

• Prepared by

• Conducted on

  Date

• N.A Not Applicable. N.C Not Checked

• 1<br>Has the severity of the hazard been considered?<br>

  Yes

  No

  N.A.

  N.C.

• 2<br>Has the expected duration of the job been determined?

  Yes

  No

  N.A.

  N.C.

3 Has the volume and type of traffic been considered, to determine the amount of road and/or footpath space which must remain open and, where applicable, the times of day when greater amounts of space are required, including the following types of traffic:

•  Pedestrians – including disabled persons;

  Yes

  No

  N.A.

  N.C.

•  Bicycles;

  Yes

  No

  N.A.

  N.C.

•  School children;

  Yes

  No

  N.A.

  N.C.

•  Emergency vehicles;

  Yes

  No

  N.A.

  N.C.

•  Buses and light rail, including stops and terminals;

  Yes

  No

  N.A.

  N.C.

•  Over-dimensional vehicles.

  Yes

  No

  N.A.

  N.C.

• 4<br>Has the type of traffic routing required been assessed?

  Yes

  No

  N.A.

  N.C.

• 5<br>Has the type of traffic control required been determined?

  Yes

  No

  N.A.

  N.C.

• 6<br>Will traffic controllers be required for intermediary arteries?

  Yes

  No

  N.A.

  N.C.

• 7<br>Will police or RMS be required to institute diversions?

  Yes

  No

  N.A.

  N.C.

• 8<br>Is there an impact on any main arterial roads?

  Yes

  No

  N.A.

  N.C.

• 9<br>Is the site in proximity to traffic lights?

  Yes

  No

  N.A.

  N.C.

• 10<br>Is special lighting is required?

  Yes

  No

  N.A.

  N.C.

• 11<br>Has the positioning of cones and early warning signs been considered?

  Yes

  No

  N.A.

  N.C.

12 Has training been provided to workers working on roads, including:

•  Wearing the appropriate personal protective and safety equipment?

  Yes

  No

  N.A.

  N.C.

•  Being properly located?

  Yes

  No

  N.A.

  N.C.

•  Communicating effectively?

  Yes

  No

  N.A.

  N.C.

•  Assessing changes in traffic patterns?

  Yes

  No

  N.A.

  N.C.

•  Knowing what to do in an emergency?

  Yes

  No

  N/A

13 Is there adequate maintenance of records including:

• <br> installation, alteration and removal of all regulatory signs and devices, including speed restriction signs,

  Yes

  No

  N.A.

  N.C.

•  hours of operation and the surface conditions?

  Yes

  No

  N.A.

  N.C.

• Is the activity compliant.

  Yes

  No

  N.A.

  N.C.

• Surveillance Officer

  Sign

• NCPN or memo number.

  Yes

  No

  N/A

• Follow up action

  Yes

  No

  N/A

• Product Non Conformance

  Yes

  No

  N/A

• System Non Conformance

  Yes

  No

  N/A

• Contractor generated NCR

  Yes

  No

  N/A

• Contractor generated a CAR

  Yes

  No

  N/A

Matters arising

• NCPN no

• Contractors NCR no

• CAR no

• Closed out.

• RMS representative's name

  Sign