Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Signal Identification

  • Date and Time Notified of Accident

  • Date and Time Arrived on Site

  • Has the Duty Officer being Notified?

  • Is CCTV Present on Site?

  • Photo's of Initial incident

  • TNS Site Risk Assessment Completed

  • Are Police details available?

  • Officer 1 - Name, Badge, Station and QPS

  • Officer 2 - Name, Badge, Station and QPS

  • Are Vehicle / Driver Details Available?

  • Vehicle 1 - Registration, Vehicle Type, Driver Details/Address

  • Vehicle 2 - Registration, Vehicle Type, Driver Details/Address

Signal Action

  • What work was done to rectify

  • Earth Continuity Completed? Result Recorded?

  • Further Action Required

  • Bell Joint Used

  • Materials Damaged

  • Materials to be Re-used

  • Is any other BCC Infrastructure damaged as a result of Accident. i.e street signs, bus shelter

  • Has the Call Centre been notified of the damage? Note reference number.

  • Photo of how the site was left

Site Resource Utilisation

  • Site Diary Completed?

  • Staff on Site - Payroll, Name, Hours

  • Fleet on Site - Fleet Number, Fleet Type, Hours

  • Supplier/Hire Company on site

Sign Off

  • Date and Time Finished on Site

  • Add signature

  • Add signature

  • Add signature

  • Add signature

Further Works Completion

  • Action taken to complete job 1

  • Technician

  • Date / Time Restored

  • Supervisor

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.