Audit Form

• Conducted on

  Date

• Prepared by

• Location
  Address
• Client:
  Address

• Address:

• Municipal or DOT

• MOA # (If Applicable):

• Council Permit # (If Applicable)

• TGS/TMP #:

• Client:

• Client Supervisor:

Vehicle Details

• Ute 1 Registration:

• Driver 1:

• Licence #:

• Ute 2 Registration:

• Driver 2:

• Licence #:

• Ute 3 Registration:

• Driver 3:

• Licence #:

• Ute 4 Registration

• Driver 4:

• Licence #:

Crew Details

• Yes

  No

  N/A

• Team Leader Name

• White Card

  Yes

  No

  N/A

• RIIWHS302E – Implement Traffic Management Plans

  Yes

  No

  N/A

• RIIWHS205E Control traffic with stop-slow bat

  Yes

  No

  N/A

• Offside TC 1 Name

• White Card

  Yes

  No

  N/A

• RIIWHS302E – Implement Traffic Management Plans

  Yes

  No

  N/A

• RIIWHS205E Control traffic with stop-slow bat

  Yes

  No

  N/A

• Offside TC 2 Name

  Yes

  No

  N/A

• White Card

  Yes

  No

  N/A

• RIIWHS302E – Implement Traffic Management Plans

  Yes

  No

  N/A

• RIIWHS205E Control traffic with stop-slow bat

  Yes

  No

  N/A

• Offside TC 3 Name

  Yes

  No

  N/A

• White Card

  Yes

  No

  N/A

• RIIWHS302E – Implement Traffic Management Plans

  Yes

  No

  N/A

• RIIWHS205E Control traffic with stop-slow bat

  Yes

  No

  N/A

Site Constraints

• What are the weather conditions?

  Good

  Fair

  Poor

  N/A

• Has the site been set up considering weather conditions?

  Yes

  No

  N/A

• Is there adequate line of sight on approach to the job site?

  Yes

  No

  N/A

• Is there a train station near works? If yes have increased pedestrian movements been considered?

  Yes

  No

  N/A

• Yes

  No

  N/A

Items for Inspection:

• Arrow Board Operating?

  Yes

  No

  N/A

• Beacons Operating?

  Yes

  No

  N/A

• First Aid Kit On Board Vehicle?

  Yes

  No

  N/A

• Site File On Board Vehicle?

  Yes

  No

  N/A

• Daily Pre-Start Vehicle Inspection Complete?

  Yes

  No

  N/A

• TMP/TGS Implemented correctly as per Generic/Approved Plan?

  Yes

  No

  N/A

• Pedestrian and Motorists understanding/adhering to TGS?

  Yes

  No

  N/A

• Signage setup correctly including flags?

  Yes

  No

  N/A

• Are signs gated if required?

  Yes

  No

  N/A

• Are repeaters implemented? If yes are they gated for dual lane and on the left for single lane each direction?

  Yes

  No

  N/A

• Are all multi message frames in tact? Any damaged or broken frames?

  Yes

  No

  N/A

• Are all core flutes clean, in tact and reflective?

  Yes

  No

  N/A

• Are flags clean, in tact and bright?

  Yes

  No

  N/A

• Are cones/bollards clean, in tact and reflective?

  Yes

  No

  N/A

• Correct spacing between Signage in accordance with relevant road speed?

  Yes

  No

  N/A

• Taper length in correlation with relevant road speed?

  Yes

  No

  N/A

• Has VicRoads been notified?

  Yes

  No

  N/A

• Have ALL SWMS applicable been dated and signed along with address listed for job by ALL employees?

  Yes

  No

  N/A

• Is the required PPE in use and adhered to in accordance with relevant job (Day/Night)?

  Yes

  No

  N/A

• Is PPE clean, not faded or ripped?

  Yes

  No

  N/A

• Does the crew understand evacuation points or understand where to find procedure during Emergencies?

  Yes

  No

  N/A

• Have measures been taken to remove/cover any contradictory, distracting or unnecessary signs or markings?

  Yes

  No

  N/A

• Are Signs/Bats free of damage / defects or Non-Reflectivity?

  Yes

  No

  N/A

• Have Pedestrian, Cyclist and the Disabled needs been considered?

  Yes

  No

  N/A

• Stop/Slow bats at hand

  Yes

  No

  N/A

• Are containment fences / no go zones required and installed?

  Yes

  No

  N/A

• Are trailer or vehicle mounted flashing arrows in use where necessary?

  Yes

  No

  N/A

• Are vehicles in good & clean condition with company logos?

  Yes

  No

  N/A

• Are fire extinguishers present and the tag within a six month inspection date?

  Date

Traffic Controller Conduct

• Yes

  No

  N/A

Inspection Points

• Are all traffic controllers displaying appropriate behaviour/conduct on site & representing themselves in adherence with company protocol?

  Yes

  No

  N/A

• Have all workers (including traffic controllers) been consulted on work related matters affecting safety (Toolbox Meeting if applicable/SWMS/JSEA)?

  Yes

  No

  N/A

• Is there an adequate amount of traffic controllers on site in accordance with breaks/rest requirements of personnel?

  Yes

  No

  N/A

• Is the team leader regularly checking signage to ensure signage hasn’t flipped down or if signage has been amended to suit moving works if necessary?

  Yes

  No

  N/A

• Do all TCs have a clear escape path?

  Yes

  No

  N/A

Night Work Conduct

• Do all traffic controllers have a reliable method of communication?

  Yes

  No

  N/A

• Are all traffic controllers wearing correct high visibility clothing in correlation with Night PPE requirements?

  Yes

  No

  N/A

• Is there adequate lighting that supports good visibility at night for workers & road users?

  Yes

  No

  N/A

• Have all traffic controllers been provided lighted wands to direct traffic?

  Yes

  No

  N/A

Audit Summary:

• undefined

Highlights (Positive Feedback):

• undefined

Problematic Areas (Potential Risks/Incorrect):

• undefined

Corrective Actions (How to rectify any potential risks/incorrect issues):

• Additional Comments:

• Auditor:

• Signature:

  Sign

• Date:

  Date