HDC SITE CONDITION RATING FORM (FULL AUDIT)

Site Details

• RCA

  Horowhenua DC

  NZTA

• Suburb

  Select Levin Foxton Shannon Manakau Waikawa Beach Tokomaru Hokio Beach Waitarere Beach Foxton Beach

  • Levin
  • Foxton
  • Shannon
  • Manakau
  • Waikawa Beach
  • Tokomaru
  • Hokio Beach
  • Waitarere Beach
  • Foxton Beach
• Road Name/Location
  Address

• CAR/WAP Number

• Road ID

• Date / time of Audit

  Date

• TTM Level

Operational Details

• Activity Description

• TTM Method

• TTM Contractor

• Contractor - Working Space

• Client/Principal

SIGNS

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

• Position - 2 points for each sign

• Not visible/Fallen Over - 3 points for each sign

• Wrong sign - 5 points for each sign

• Condition Unacceptable - 4 point for each sign

• Permanent signs not covered - 5 for each sign

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

• Non-compliant support/Sign Too Low - 2 for each support

MOBILE & SEMI STATIC

• Tail pilot vehicle/AWVMS omitted or incorrect location - 30 points for missing or incorrect location

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

• Shadow vehicle omitted or incorrect location - 26 points for missing or incorrect location

• TMA missing or non compliant - 26 points for TMA missing or non compliant when required

• AWVMS/Arrowboard non compliant - 26 points for arrowboard missing when required

PEDESTRIANS/CYCLISTS

• Inadequate provision for pedestrians

• inadequate provision for cyclists

DELINEATION

• Missing or Ineffective Taper (Leading Taper) - 26 points where delineation is missing and required

• Tapers too short (Leading Taper) - 15 points for each taper

• Tapers too short or missing (Trailing Taper) - 5 points for each taper

• Spacing in taper - 5 points where spacing is incorrect

• Spacing along lanes (Per 100m) - 3 points where spacing is incorrect

• Missing or ineffective delineation along lanes (Per Section) - 10 points for each section

• Conditional Unacceptable (Per device) - 2 points for each device where classified in unacceptable condition

• Using non-approved device (Per Device) - 4 points for each non-approved device

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

• Inadequate/Missing site access - 10 points for each missing or installed incorrectly

MISCELLANEOUS

• Working in live lanes - 20 points for each occasion

• Missing or ineffective controller - 20 point for each vehicle

• Safety zone compromised - 10 points for unacceptable or no safety zone

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

• Marginal surface condition (carriageway only - One off) - 15 points where no provision made and required

• Unacceptable surface condition (peds, cyclists or carriageway - one off) - 30 points where no provision made and required

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

• Unsafe or redundant TTM - 5 points where relocation of feature is required but has not been made

• VMS message incorrect or inappropriate - 15 points for displaying incorrect information

• Flashing beacons/indicator lights not used or ineffective - 3 points for not used or ineffective

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

• Unsafe and illegal parking of plant/equip - 20 points for each

• Marginal items (signs, delineators, Hi vis garments) - 1 point for each in unacceptable condition

OTHER WORKSITE ASPECTS

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

  Yes

  Unacceptable

  N/A

• TSL appropriate [refer to C4 of CoPTTM]

  Yes

  Unacceptable

  N/A

• Road user flow acceptable

  Yes

  Unacceptable

  N/A

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

  Yes

  Unacceptable

  N/A

• TMP approved?

  Yes

  Unacceptable

  N/A

• Approved TMP sighted?

  Yes

  Unacceptable

  N/A

• Approved TMP applicable?

  Yes

  Unacceptable

  N/A

• TTM in accordance with approved TMP?

  Yes

  Unacceptable

  N/A

FINAL RESULT

• Rating = High Standard (0-10)

• Rating = Acceptable (11-25)

• Rating = Needs Improvement (26-50)

• Rating = Unacceptable - Other (other aspects only)

• Rating = Unacceptable (51+ Only)

• Rating = Unacceptable - Multiple (Both 51+ and Other Aspects)

• Rating = Dangerous (SCR 51+ and Low Risk? rated No)

Actions Planned By STMS

• Site Fixed?

  Yes

  No

• Site Activity Ceased By

  Brent Tucker

  Mick Longley

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

ACTIONS TO BE TAKEN

• Agreed Actions To Be Taken

AUDITED/REVIEWED BY

• Signature

  Sign

• Auditor/Reviewer Name

  Select Brent Tucker Mick Longley

  • Brent Tucker
  • Mick Longley

• 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/Signed

  Sign

• STMS Name

• 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)