CRM Preliminary Assessment

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Overview

• Complaint Type

  Customer request

  Referral from within Council

  Work permit application

  Other

• Infrastructure Type

  Select Road Footpath Kerb & Channelling Table Drain Storm-water pipes / pits Open Channel Street Lights Street Signs Street Furniture Driveway Crossing

  • Road
  • Footpath
  • Kerb & Channelling
  • Table Drain
  • Storm-water pipes / pits
  • Open Channel
  • Street Lights
  • Street Signs
  • Street Furniture
  • Driveway Crossing

• Hazard Type

  Select Trip displacement Cracked /broken Cracking / trip Tree root Rotation Vertical displacement Cracked / broken / spalling Street signsPonding / depression Rutting Roughness Pavement defects

  • Trip displacement
  • Cracked /broken
  • Cracking / trip
  • Tree root
  • Rotation
  • Vertical displacement
  • Cracked / broken / spalling
  • Street signsPonding / depression
  • Rutting
  • Roughness
  • Pavement defects

• RISK RATING

• Council infrastructure

  Low risk

  Medium risk

  High risk

  Extreme risk

• Private property

  Low risk

  Medium risk

  High risk

  Extreme risk

ASSESSMENT WEIGHTING CRITERIA

• Any service infrastructure within close proximity (eg sewer, water, storm water)

  Yes

  No

  N/A

• Links to approved future works plans

  Yes

  No

  N/A

• Links to gravel road sealing program

  Yes

  No

  N/A

• Any above ground infrastructure ?

  Yes

  No

  N/A

• Replacement/refurbishment of existing infrastructure?

  Yes

  No

  N/A

• Completion of missing link which is integral to the functioning of the infrastructure network?

  Yes

  No

  N/A

• New infrastructure as identified in Fraser Cost Priority Infrastructure Plan (PIP) or Walk & Cycle Plan

  Yes

  No

  N/A

• VEHICLE USAGE - include AADT if pre-existing data has been allocated

• High Use - CBD areas, shopping centers, aged care facilities, Hospitals, Schools

  Yes

  No

  N/A

• Medium Use - Parks adjoining High areas, churches and aged homes within urban areas; all medium or high density residential zones; strip shops or corner shops in residential areas. In parks, reserves and lane ways with unlimited access.

  Yes

  No

  N/A

• Low Use - All other areas.

  Yes

  No

  N/A

BACKGROUND, OUTCOMES & ACTIONS

• 1. Issue Raised

• CRM compliant raised as provided to Investigations Officer

• Add media

  Media

• 2. Background

• Any history or related information to issue raised

• 3. Response to issue raised

• Response to above issues are:

• Add media

  Media

• 4. Consultation

• Identify who has been consulted in the process:

• 5. Proposal

• Identify possible actions for consideration:

• Add media

  Media

ADDITIONAL INFORMATION

• Any additional information?

• Sketch (if required)

  Drawing

• Inspectors Name

  Sign