• Document No.

  • Address of hazard

  • Conducted on Month/ Date/Year

  • Prepared by

  • Location


  • Is there a defect

  • Type of defect, trip, drop off, damage, broken,slippery,cleaning

  • Add media

  • Action required

  • Type of action required ( grind, top up, replace,repair,steam clean,clearing)

Rating score of defect

  • Rating of defect 0 - Brand New, Pathway is in Perfect Condition 1- Very Good Condition- No Visible Defects 2- Good Condition- Only very Minor Defects Found 3- Average Condition- A number of defects are visible,but is still quite serviceable 4- Below Average Condition- Quite a few obvious defects are visible 5- Poor Condition- significant percentage of footpath exhibiting severe cracking and other defects 6- Very poor condition- totally unsuitable for pedestrian use.

Completion details

  • Action taken

  • Works completed by

  • Date of Works Completed.

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