Information

  • Document No.

  • Job Title (Client Name, Site Name)

  • Client

  • Client Name

  • Audit Conducted on

  • Auditor Name

  • Enter Auditor's Name

  • STMS Name

  • Enter STMS's Name

  • Location of Site

Site Info

  • Description of Site Activity Construction works New interchange

  • Level of TTM:

  • Description of TTM Installed:

  • RCA

  • Actions Taken (to be completed at audit end)

  • TMP Sited:

  • TMP Ref No:

Audit Scoring

Signs

  • Number of Signs Missing

  • Number of Signs too close/far

  • Number of signs not visible

  • Number of Signs whose Condition is Marginal

  • Number of Signs whose condition is unacceptable

  • Number of SETS of Signs whose order is incorrect

  • Number of permanent signs not covered

  • Number of Unapproved Signs used/too small

  • Number of signs on the wrong side

  • Number of Signs that are too low

  • Number of occasions where speed restrictions/de-restrictions are not appropriate/inconsistent

  • Number of occasions where speed limit is not correctly aligned

  • Number of signs that are not upright

  • Number of signs with non-compliant support

  • Number of instances where the wrong sign has been used

  • Number of signs with Lateral Location

Delineation Devices

  • Number of instances where delineation is missing or required

  • Number of Tapers that are too short

  • Number of instances where spacing between tapers is too great to be effective

  • Number of instances where the spacing in lanes/around work areas is too great

  • Number of delineation devices whose conditions are marginal

  • Number of delineation devices in an unacceptable condition

  • Number of instances where an unapproved device has been used

  • Number of instances where delineation devices had been used incorrectly

  • Road marking incorrect (where not adjusted on long term sites on Level 2 or 3 roads

  • Number of each missing or installed incorrectly

Miscellaneous

  • Working in Live Lanes

  • Flashing beacons not used/ineffective

  • High visibility garment not worn

  • No provision for pedestrians (where required)

  • No provision for cyclists (where required)

  • Parking/Stopping features not relocated (where required)

  • Safety (long) zone unacceptable or non-existent

  • Safety (lateral) zone unacceptable or non-existent

  • High visibility garment marginal

  • High visibility garment unacceptable

  • Excavation not protected by acceptable method

  • VMS message incorrect

  • Barrier defects (missing or incorrect barrier component)

Mobile & Semi-Static Operation

  • Tail pilot vehicle omitted (missing or incorrect location)

  • Lead pilot vehicle omitted (missing or incorrect location)

  • Shadow vehicle omitted

  • Vehicle mounted signs missing or in incorrect location

  • TMA missing when required

  • TMA non compliant (in-use but of an acceptable standard)

  • Arrow board missing (when required)

  • Arrow board message missing or incorrect (when required)

  • General Observations:

Advanced Warning Zone

  • Signage

  • Visibility

  • Placement

  • Quality

Direction & Protection Zone

  • Signage

  • Visibility

  • Placement

  • Quality

  • Delineation

  • Placement

  • Quality

  • Spaced Correctly

Other Issues

  • Excavations

  • Pedestrians from work

  • Pedestrians from traffic

  • Cyclists from work

  • Cyclists from traffic

  • Safety spaces/zones

  • Warning lights

  • Vehicles operating with traffic flow

  • Vehicles parked with traffic flow

  • Vehicles outside zone

  • Entering/Leaving with traffic flow

  • Workers safety

  • STMS/TC on site

End of Works

  • Sign Placements

  • Sign Quality

Safety Gear & Equipment

  • Hard Hat

  • Hi-Viz Vest

  • Boots

  • Gloves

  • Glasses

  • Ear Muffs

  • Uniform

  • Harness

  • Light Wands

  • RTs

Vehicle

  • Warrant of Fitness

  • Road User Charges

  • Registration

Documents

  • Approved TMP

  • TMP Expiry Date

  • Documented Changes

  • Daily Job Record

  • Hazard Sheet

  • Daily Closure Sheet

  • Watercare DJR

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.