Information

  • Audit Title

Auditor

  • Auditor Name

  • Qualification

  • Reg. No.

Contractor

  • Contractor

  • STMS Name

  • Qualification

  • Reg. No.

Site location / details

  • Client / Site

  • Location
  • Activity

  • Level of TTM

  • RCA

  • Client

  • TMP sighted

  • Date / time of Audit

Signs

Signs

  • Missing (including side road) - 5 for each sign

  • Spacing (too close/far) - 2 points for each sign

  • Not visible - 3 points for each sign

  • Condition Marginal - 1 point for each sign

  • Order Incorrect - 2 points for each set of signs out of order

  • Permanent signs not covered - 2 for each sign

  • Unapproved signs used / too small - 4 for each sign

  • Sign on wrong side - 2 points for each sign

  • Sign too low - 1 point for each sign

  • Speed restriction / derestriction not appropriate / inconsistent - 5 points for each occasion

  • Speed limit not correctly aligned - 2 points for each occasion

  • Sign not upright - 1 point for each sign

  • Non-compliant support - 2 for each support

  • Wrong sign - 5 points for each sign

  • Lateral location - 1 point for each sign

Delineation Devices

Delineation Devices

  • Missing - 30 points where delineation is missing and required

  • Tapers too short - 5 points for each taper

  • Spacing in tapers - 3 points for each taper

  • Spacing in lanes - 2 points where spacing in lanes / around work area is too great

  • Condition Marginal - 1 point for each device where classified in marginal condition

  • Conditional Unacceptable - 3 points for each device where classified in unacceptable condition

  • Using non-approved device - 4 points for each non-approved device

  • Used incorrectly - 2 points for each device

  • Road Marking incorrect - 5 points where not adjusted at long term sites on Level 2 or 3 roads

  • Chicane - 10 points for each missing or installed incorrectly

Miscellaneous

Miscellaneous

  • Working in live lanes - 20 points for each occasion

  • Flashing Beacons not used / ineffective - 1 point for each vehicle

  • High visibility garment not worn - 5 points for each individual

  • No provision for pedestrians - 10 points where no provision made and required

  • Parking / stopping features not relocated - 5 points where relocation of feature is required but has not been made

  • No provision for cyclists - 5 points where no provision made and required

  • Parking / stopping features not relocated - 5 points where relocation of feature is required but has not been made

  • Safety (long) zone compromised - 2 points for unacceptable or no safety zone

  • Safety (lateral) zone compromised - 2 points for unacceptable or no safety zone

  • High visibility garment marginal - 3 points for each garment in marginal condition

  • High visibility garment unacceptable - 5 points for each garment in unacceptable condition

  • Excavation not protected - 10 points for excavation not protected by acceptable method

  • VMS message incorrect - 10 points for displaying incorrect information

  • Barrier defects - 10 points for each incorrect or missing barrier component

Mobile & Semi Statics Operations

Mobile & Semi Statics Operations

  • Tail pilot vehicle omitted - 20 points for missing or incorrect location

  • Lead pilot vehicle omitted - 20 points for missing or incorrect location

  • Shadow vehicle omitted - 20 points for missing or incorrect location

  • Vehicle mounted signs - 20 points for missing or incorrect location

  • TMA missing - 20 points for TMA missing when required

  • TMA non-compliant - 5 points for TMA in use but not of acceptable standard

  • Arrowboard missing - 20 points for arrowboard missing when required

  • Arrowboard message - 20 points for no message or incorrect message

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.