Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • 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 <br><br>

  • 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

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.