DCC Site Condition Rating Form

Site Details

• RCA

  Dunedin City Council

• Suburb

• Road Name/Location

• CAR/WAP Number

• Road ID

• Date / time of Audit

  Date

• TTM Level

  Low Volume

  Level 1

  Level 2

Operational Details

• Activity Description

  Select Digout Footpath Construction Footpath Prep Footpath Resurfacing Kerb and Channel Renewal Road Resurfacing Road Widening Safety Improvements Service Connection Stabi Streetlight Maintenance Other

  • Digout
  • Footpath Construction
  • Footpath Prep
  • Footpath Resurfacing
  • Kerb and Channel Renewal
  • Road Resurfacing
  • Road Widening
  • Safety Improvements
  • Service Connection
  • Stabi
  • Streetlight Maintenance
  • Other

• Other:

• TTM Method

  Select Footpath Closure Full Road Closure Lane Closure Partial Road Closure Speed Restriction Stop/Go

  • Footpath Closure
  • Full Road Closure
  • Lane Closure
  • Partial Road Closure
  • Speed Restriction
  • Stop/Go

• TTM Contractor

  Select Broadspectrum Downer NZ Ltd Fulton Hogan Ltd SouthRoads TMC OTHER

  • Broadspectrum
  • Downer NZ Ltd
  • Fulton Hogan Ltd
  • SouthRoads
  • TMC
  • OTHER

• Other:

• Contractor - Working Space

  Select Broadspectrum Downer NZ Ltd Fulton Hogan Ltd SouthRoads TMC OTHER

  • Broadspectrum
  • Downer NZ Ltd
  • Fulton Hogan Ltd
  • SouthRoads
  • TMC
  • OTHER

• Other:

• Client/Principal

  Dunedin City Council

SIGNS

• A1 Missing [Sign] - Weighting (5)

• A2 Position [Sign] - Weighting (2)

• A3 Not visible/Fallen Over [Sign] - Weighting (5)

• A4 Wrong sign [Sign] -Weighting (5)

• A5 Condition Unacceptable [Sign] - Weighting (4)

• A6 Permanent sign [Sign] - Weighting (5)

• A7 Unapproved signs used / too small [Sign] - Weighting (4)

• A8 Non-compliant support/Sign too low [Support] - Weighting (2)

MOBILE & SEMI STATIC

• B1 Tail pilot vehicle/AWVMS omitted or incorrect location [Vehicle] - Weighting (30)

• B2 Lead pilot vehicle omitted or incorrect location [Vehicle] - Weighting (20)

• B3 Shadow vehicle omitted or incorrect location [Vehicle] - Weighting (26)

• B4 TMA missing or non compliant [TMA] - Weighting (26)

• B5 AWVMS/Arrowboard non compliant [Vehicle] - Weighting (26)

PEDESTRIANS/CYCLISTS

• C1 Inadequate provision for pedestrians [Feature] - Weighting (10)

• C2 inadequate provision for cyclists [Feature] - Weighting (10)

DELINEATION

• D1 Missing or Ineffective Taper [Leading Taper] - Weighting (26)

• D2 Tapers too short [Leading Taper] - Weighting (15)

• D3 Tapers too short or missing [Trailing Taper] - Weighting (5)

• D4 Spacing in taper [Taper] - Weighting (5)

• D5 Spacing along lanes [Per 100m] - Weighting (3)

• D6 Missing or ineffective delineation along lanes [Per Section] - Weighting (10)

• D7 Conditional Unacceptable [Device] - Weighting (2)

• D8 Using non-approved device [Device] - Weighting (4)

• D9 Road Marking incorrect at long term level 2 or 3 roads [Site] - Weighting (30)

• D10 Inadequate/Missing site access [Access] - Weighting (10)

MISCELLANEOUS

• E1 Working in live lanes [Individual] - Weighting (20)

• E2 Missing or ineffective controller [Individual] - Weighting (20)

• E3 Safety zone compromised [Individual] - Weighting (10)

• E4 High visibility garment not acceptable [Individual] - Weighting (5)

• E5 Marginal surface condition (carriageway only) [Occasion] - Weighting (15)

• E6 Unacceptable surface condition (peds, cyclists or carriageway) [Occasion] - Weighting (30)

• E7 Barrier defects (missing or incorrect components) [Component] - Weighting (10)

• E8 Unsafe or redundant TTM [Equipment] - Weighting (5)

• E9 VMS message incorrect or inappropriate [VMS] - Weighting (15)

• E10 Flashing beacons/indicator lights not used or ineffective [Vehicle] - Weighting (3)

• E11 Parking / stopping features not relocated [Feature] - Weighting (5)

• E12 Unsafe and illegal parking of plant/equip [Feature] - Weighting (20)

• E13 Marginal items (signs, delineators, Hi vis garments) [Feature] - Weighting (1)

OTHER WORKSITE ASPECTS

• G1 Qualified person on site [refer to A5 of CoPTTM]

  Yes

  Unacceptable

  N/A

• G2 TSL appropriate [refer to C4 of CoPTTM]

  Yes

  Unacceptable

  N/A

• G3 Road user flow acceptable

  Yes

  Unacceptable

  N/A

• G4 On-site record [form must include STMS authority, 2 hourly checks and TSL details]

  Yes

  Unacceptable

  N/A

• G5 TMP approved?

  Yes

  Unacceptable

  N/A

• G6 Approved TMP sighted?

  Yes

  Unacceptable

  N/A

• G7 Approved TMP applicable?

  Yes

  Unacceptable

  N/A

• G8 TTM in accordance with approved TMP?

  Yes

  Unacceptable

  N/A

FINAL RESULT

• Score:

• Rating:

  Select High Standard (0-10) Acceptable (11-25) Needs Improvement (26-50) Unacceptable - Other (Other Aspects only) Unacceptable (51+ only) Unacceptable - Multiple (both 51+ and Other Aspects) Dangerous (SCR 51+ and LOW RISK? rated NO)

  • High Standard (0-10)
  • Acceptable (11-25)
  • Needs Improvement (26-50)
  • Unacceptable - Other (Other Aspects only)
  • Unacceptable (51+ only)
  • Unacceptable - Multiple (both 51+ and Other Aspects)
  • Dangerous (SCR 51+ and LOW RISK? rated NO)

Actions Planned By STMS

• Site Fixed?

  Yes

  No

• Site Activity Ceased By

KEY POINTS

• Complaint Callout?

  Yes

  No

• Site Activity Status

  Attended

  Unattended

• Audit Review

  Planned

  Unplanned

• Notification To RCA (does not affect score)

  Yes

  No

• Good Site Induction? (does not affect score)

  Yes

  No

• TMP Design Issues?

  Yes

  No

• LOW RISK?

  Yes

  No

• Key Points Comments:

ACTIONS TO BE TAKEN

• Actions To Be Taken:

AUDITED/REVIEWED BY

• Auditor/Reviewer Name & Signature

  Sign

• Qualifications

  Select STMS Level 1 STMS Level 2 STMS Level 2/3

  • STMS Level 1
  • STMS Level 2
  • STMS Level 2/3

• NZTA ID No.

• Auditor Mobile Number

STMS DETAILS

• Received by (STMS Name)/Signed

  Sign

• Qualifications

  STMS Level 1

  STMS Level 2

  STMS Level 2/3

• NZTA ID No.

• STMS Mobile Number

• SCR Left Onsite?

  Yes

  No

• In submitting this form, the auditor/reviewer specified above agrees that they have explained the significant issues and proposed remedies to the relevant parties specified above and have provided these parties a physical copy of the audit (does not apply for unattended sites)