Inspection Record - Litter Patrol

• Conducted on

  Date

• Cleaners Name/s

• Prepared by

• Map Location
  Address

• Which Street

• Following Run Sheet

  Yes

  No

  N/A

• Correct Procedures Followed

  Yes

  No

  N/A

• MUTCD Works As Per CCOM Diagrams And Procedures

  Yes

  No

  N/A

• Has Work Been Completed To Required Standards

  Yes

  No

  N/A

• Correct break times

  Yes

  No

  N/A

• Maintenance Issues Requiring Attention

  Yes

  No

  N/A

• Comments?

Photos

• Insert all related photos

  Media

Cleaners signature

• Sign below

  Sign