Title Page

  • Conducted On:

  • Prepared By:

  • Location:

SLG

  • Have all signs been removed?

  • Have all barriers been removed?

  • Please provide S74 photos showing the road in all directions

Reinstatement

  • Please provide pictures showing reinstatement complete

  • Are all kerbs and edgings within/adjacent the reinstatement in good repair?

  • Are there any broken slabs within the reinstaement to report?

  • Have all road marking been reinstated?

  • Has the carriageway and footpath been left free of debris?

Defects

  • Are there any noticeable defect?

  • Are there any diesel/petrol/concrete spills left unattended too?

Items collected

  • How many Barriers have been collected?

  • How many ramp boards have been collected?

  • How many FWA closed signs have been collected?

  • How many FWC signs have been collected?

  • How many blue arrows have been collected?

  • How many Road narrow have been collected?

  • How many sandbags have been collected?

  • How many cones have been collected?

  • How many advanced warning signs have been collected?

Additional comments?

  • undefined

Sign Off

  • Add signature

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.