M.R.S.C Sealed Roads

• Document No.

• Conducted on

  Date

• Prepared by

Audit

• Road Name
  Address

• Distance Km

• Last Patrol Date

  Date

• Crew

Defects Above Intervention

• Pot Hole

  Yes

  No

• Pot hole

• Failure

  Yes

  No

• Failure

• Edge Break

  Yes

  No

• Edge Break

• Edge Drop Off

  Yes

  No

• Edge drop off

Defects below intervention

• Pot Hole

  Yes

  No

• Pot hole

• Failure

  Yes

  No

• Failure

• Edge Break

  Yes

  No

• Edge break

• Edge Drop Off

  Yes

  No

• Edge drop off

• Additional Defects

  Yes

  No

• Select Cracking Depressions Trees loose gravel

  • Cracking
  • Depressions
  • Trees
  • loose gravel

Audit Conclusion

• Defects marked up with paint

  Yes

  No

  N/A

• Above Intervention Defect reported before Auditor has left site

  Yes

  No

  N/A

• Below intervention defects placed on C.R.M

  Yes

  No

  N/A

• C.R.M No:

• Signature

  Sign