Title Page
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Street Name/Location
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RCA CAR/WAP Number
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Attended/Unattended
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Principal
- Horowhenua District Council
- Horowhenua Alliance
- Horizons Regional Council
- Chorus
- Electra
- Private
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Employer of Site STMS
- Higgins Contractors
- Downer NZ Ltd
- Tatanas Contracting Ltd
- CH Road Boring
- Paul Ireland Digger Hire
- Vision Stream
- Chorus
- Brian Ralph Concrete
- Bagrie Contracting Ltd
- Wayne Aldridge Contracting
- Fulton Hogan
- BCC Contracting
- Heatherlea Contractors Ltd
- Telsys
- UCG
- Broadspectrum
- Private
- Other
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Date/Time
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Rating A=Acceptable NI = Needs Improvement D= Dangerous
Responsible Party
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STMS/TC Attended at Site?
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Name
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Registration Number:
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Action Needed
TMP
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On Site?
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Appropriate To Situation?
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Action Needed
High-Visibility Garments
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Worn By All?
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Done Up?
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Condition Acceptable?
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Action Needed
Signs
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All Necessary Signs Present?
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Correct Positions?
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Sand Bagged For Expected Wind?
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Conflicting Signs Covered?
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Signs In Good Condition?
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Action Needed
Deliniation
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Protects Working Space/Other Features?
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Longitudinal Safety Zone Appropriate?
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Lateral Safety Zone Appropriate?
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Taper Lengths Compliant?
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Correct Spacing Of Cones?
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Sufficient Positive Traffic Control?
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Action Needed
Pedestrian Needs
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Footpath Widths Ok?
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Safe Passage For Pedestrians?
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Surfaces/Ramps OK?
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Action Needed
Cyclist Needs
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Cycle Widths Ok?
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Safe Passage For Cyclists?
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Surfaces OK?
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Action Needed
Traffic Needs
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Lane Widths Ok?
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Speed Limit Appropriate?
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No Significant Delays?
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Surfaces OK?
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Action Needed
Property Access
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Property Access OK?
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Action Needed
Action Agreed By STMS/TC
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Actions Agreed
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HDC Auditor Name
- Brent Tucker
- Mick Longley
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HDC Auditor STMS Number
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HDC Auditor Signature
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STMS/TC Signature
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Pictures Of Site
