Title Page

Site Details

  • Applicant

  • Road Name

  • Suburb/Locality
  • Description of Work Activity

  • Type of Occupancy

Road Conditions

  • Date/Time

  • Road Condition

  • Weather

  • Direction

  • Work Crew

  • Comments

Advanced Warning

  • Advanced Warning Signage

  • Repeater Signs

  • Speed Signs

  • Signs Duplicated

  • Is Speed Limit Appropriate for work activities

  • Comments

Traffic Management

  • Type of Traffic Control

  • Signs Displayed

  • Traffic Controller - Displaying Authority (logo and "Authorised Traffic Controller")

  • Traffic Controller - has suitable escape route

  • Traffic Signals - Operation Mode

  • Effectiveness

  • Comments

Work Site Safety

  • Plant Items - Flashing lights operating

  • Barrier Boards - Used/Positioned correctly

  • Delineation - Used/Positioned correctly

  • Workers - Appropriate clearance from Traffic/Plant

  • Comments


  • Signs Displayed

  • Signs Duplicated

  • Comments

Delay Co-ordination

  • VMS used

  • Message Displayed

  • Delay (in minutes) stopped at Traffic Controller/Traffic Signals

  • Clearance Time

  • Queue Length

  • End of Queue - Signage

  • Travel Time (first to last sign)

  • Comments

General Comments/Observations

  • Comments

  • Inspection Completed by

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.