Indicate date of inspection
Locate address

Indicate specific location

Select Route assessor name
Vehicle Information

Select type of round

Select vehicle registration at time of inspection
Road information

1. What is the speed limit on the road

2. Does the speed limit on the road change

2.1 Indicate if it increases or decreases

2.2 Please indicate the change of speed

3. Indicate the approximate time of collection / operation

3.1 Indicate reason for very early or late collection

4. Is the road liable to flooding

4.1 Note the area and type of issue

5. Is the road susceptible to adverse weather conditions

5.1 Select the weather hazard type

6. Does the road have a loose surface

6.1 Select the road surface

6.2 Specify

7. Are there any concealed entrances

7.1 Add photo of concealed entrance

7.2 Select the type of concealed entrance

7.3 Enter property / construction name / road name

8. Is the road on an incline /decline

8.1 Specify gradient - if known

9. Are there blind bends on the road

10. Is there restricted access

10.1 Select the type of restricted access

10.2 add photo of restriction

11. Is there adequate lighting on the road

12. Are there speed cameras located on the road

12. Is there mud on the road

13.1 Can a Mechanical sweeper be deployed

13.2 Have West Sussex county highways been informed

13.3 record any reference number

14 Is there a major junction

14.1 Name the junction or crossroads

15 Are there any significant pot holes

15.1 Have West Sussex highways been informed

15.2 Record of any actions and reference number

16 Is there a school / college or community centre located on the road

16.1 Record the name of the establishment

17 Does the road have an adverse camber

18 Are there roadworks or utility works being on the road

18.1 Indicate company

18.2 Indicate time scale

18.3 Has. Contingency plan been put in place

18.4 Brief description of action

19 Is there restricted space to manoeuvre

19.1 Indicate the type of restriction

19.2 add photo of restriction

20 Are there overhanging trees

20.1 Photograph of obstruction

20.2 Indicate the road type if known

20.3 If known highway Has West Sussex county highways been informed

20. 4 Action of highways and the ref number

20.5 Is there a property name nearby

Record property name

21. Are there heavily shaded areas

Sign off

22. Have all the Hazards been identified

23. Record new hazards

24. Action to be completed by

Set date for completion of actions
25. SERCO Supervisor
MSDC Officer
Set date to review route
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.