Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Site location
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Date / Time of inspection
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Person Conducting Inspection
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Works Type
- Stop Slow Control
- Standard Lane Closure
- Lane Closure With Chicane
- Multi Directional Lane Supression
- Contraflow
- Lateral Shift
- Road Closure
- Part Road Closure
- Emergency Works
- Shoulder Closure
- Mobile Works
- Frequently Changing Worksite
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Road configuration
- single lane One Direction
- Single Lane Both Directions
- Multi lane One Direction
- Multi Lane Both Directions Undevided
- Multi Lane Both Directions Devided
- Intersection
- Sliplane
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Road Type
- Straight
- Hill
- Intersection
- dirt / gravel
- wet
- dry
- Corner
- Roundabout
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TGS for works on site
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ROL required
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Pre Start safety meeting has been conducted with all staff
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Licences and tickets have been inspected
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All persons have signed onto SWMS and JSA
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Brief sketch of workzone
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WORKS MAY NOT BEGIN UNTIL A ROLLING SAFTEY INSPECTION OF THE SITE HAS BEEN CONDUCTED
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A Rolling inspection has been conducted
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Time of rolling inspection
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Rolling inspection conducted by
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The site is safe to begin works
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Signage and devices have been implemented according to the TGS
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Provision has been made for pedestrians
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Provision has been made for cyclists and persons with prams and wheelchairs
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Overhead power has been marked with signage and devices
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Traffic controllers will maintain a safe escape route
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Traffic flow has been monitored and is satisfactory with the implementation of the TGS
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Existing speed signage has been covered
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Worker exclusion and retention zoning has been implemented
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ROL
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Identify any site specific hazards
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Crew 1
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Crew 2
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Crew 3
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Crew 4
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Crew 5
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Crew 6
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Supervisor
