Home
Construction
Periodic Pavement Site Validation - Rehabilitation
Periodic Pavement Site Validation - Rehabilitation
NEMA Projects

Periodic Pavement Site Validation - Rehabilitation

This inspection is used for onsite inspection of periodic rehabilitation sites

Use this Template
Print as PDF
graphic of a hand making an okay sign ×

Free Periodic Pavement Site Validation - Rehabilitation Checklist

Use this Template

Title Page

  • Site ID

  • Conducted on

  • Prepared by

Location

  • Road Name

  • Road Number

  • RMC

  • Direction

  • MABC

  • MABC Number

  • Municipality

  • SRRS Start (m)

  • SRRS End (m)

  • KM Start (km)

  • KM End (km)

  • GPS Start
  • GPS End

  • General Location comments

Inspection - Existing

  • Existing surface

  • Other surface

  • Existing aggregate size

    • 5
    • 7
    • 10
    • 14
    • 20
    • 14/7
    • 20/7
    • Other

  • Other size

  • Extent of cracking

  • Extent of patching

  • Priority

  • Major Structures

    • Structure Number

  • Structure Number

  • Minor culverts

  • Mark on sketch and add to AMIS if not there

  • Pits and Valves

  • Mark on sketch

  • Kerb and Channel

  • Residential area

  • Businesses in vicinity

  • Farms in vicinity

  • Emergency facilities in vicinity

  • In town

    • Intersecting Roads

  • Intersecting roads?

  • Road Name

  • Location

  • Other assets / services

Proposed Treatment

  • Treatment

  • Comments (including reasons for treatment selection, type of defects within site, drainage issues, etc)

  • Suction Sweeper (N if shoulders are unsealed or asphalt treatment)

  • 2 attenuators (Y if on GV or Hume freeways)

Alternative Treatment

  • Treatment

  • Comments (including reasons for alternative treatment selection)

Site Elements

    Elements

  • Element

    • L1 - Lane 1
    • L2 - Lane 2
    • PL - Passing Lane
    • RS - Right Shoulder
    • LS - Left Shoulder
    • TS - Turn Slot
    • LT - Left Turn
    • RT - Right Turn
    • B - Bell
    • LWP - Left Wheel Path
    • RWP - Right Wheel Path
    • FW - Full Width
    • CR - Centre of Road
    • P - Path
    • BWP - Between Wheel Path
  • Start Location
  • End Location

  • Start KM

  • End KM

  • Length (m)

  • Width (m)

  • Depth (m)

  • QTY

  • UOM

  • Comments

Site Considerations

  • Risks

    • Power lines
    • Sight distance
    • Traffic movements
    • Pedestrians
    • Out ofhours work
    • Traffic queuing causing flushing / plucking
    • None

  • Other

  • Comms Required

    • Letter drop
    • VMS
    • Paper
    • Shire
    • Emergency Services
    • Real Time
    • None

  • Comments

Stacksite

  • Stacksite No.

  • axim_ID

  • Location

  • Comments (including condition, size, etc)

  • Photos

Pavement Marking

  • Line Marking replacement

  • Paint (m)

  • Long Life (m)

  • Stripe (m)

  • Semi (m)

  • Double (m)

  • Single (m)

  • Edge 100 (m)

  • Edge 150 (m)

  • Tactile Edge (m)

  • Tactile Stripe (m)

  • Tactile Semi (m)

  • Tactile Double (m)

  • Centre L Black Tactile (m)

  • Edge L Black Tactile (m)

  • Continuity (m)

  • Give Way (m)

  • Stop (m)

  • Arrows (No.)

  • Chevrons (No.)

  • RRPM W (No.)

  • RRPM Y (No.)

  • RRPM R (No.)

  • RRPM G (No.)

  • Other

  • Tactile Replacement

  • Edge Line Length (m)

  • Centre Line length (m)

  • Comments

Condition Data (desktop validation - not for completion onsite)

  • RIPC Site

  • axim_ID

  • Ave. PCI

  • Texture Depth

  • % Cracking

  • Roughness

  • Rutting

  • Deflection

  • One-way AADT

  • Two-way AADT

  • EHV %

  • Growth Rate

  • Year

  • Posted Speed

Other Assets

  • Where possible, please consider updating assets which are not yet captured, or existing but not correct, in AMIS

    • Table Drains

  • Table Drains

  • Location

  • Side

  • Condition

  • Length (m)

  • Treatment required?

  • Description of work required

  • Other Comments

  • Photos

    • Culverts

  • Culverts

  • Location

  • Condition

  • Type

  • Size (mm)

  • QTY

  • Treatment required?

  • Description of work required

  • Other Comments

  • Photos

    • Kerb and Channel

  • Kerb and Channel

  • Location

  • Side

  • Condition

  • Type

  • Length (m)

  • Treatment required?

  • Description of work required

  • Other Comments

  • Photos

    • Pits

  • Pits

  • Location

  • Side

  • Condition

  • Type

  • Size (mm)

  • QTY

  • Treatment required?

  • Description of work required

  • Other Comments

  • Photos

    • Guard Rail

  • Guard Rail

  • Location

  • Side

  • Condition

  • Type

  • Length (m)

  • Treatment required?

  • Description of work required

  • Other Comments

  • Photos

    • Safety Barriers

  • Safety Barriers

  • Location

  • Side

  • Condition

  • Type

  • Length (m)

  • Treatment required?

  • Description of work required

  • Other Comments

  • Photos

    • Signs

  • Signs

  • Location

  • Side

  • Condition

  • Type

  • Treatment required?

  • Description of work required

  • Other Comments

  • Photos

    • Medians

  • Medians

  • Location

  • Condition

  • Length (m)

  • Width (m)

  • Treatment required?

  • Description of work required

  • Other Comments

  • Photos

    • Major Structures

  • Major Structures

  • Location

  • Identifier

  • Structure Form

  • Condition

  • Length (m)

  • Treatment required?

  • Description of work required

  • Other Comments

  • Photos

    • Other Assets

  • Other

  • Other description

  • Location

  • Side

  • Condition

  • Length (m)

  • QTY

  • Treatment required?

  • Description of work required

  • Other Comments

  • Photos

Site Photos

  • Add images

Site Sketch

  • Site Sketch

  • Map Photo

Submit

  • Ready to submit

  • Sign here

Periodic Pavement Site Validation - Rehabilitation
NEMA Projects

Periodic Pavement Site Validation - Rehabilitation

This inspection is used for onsite inspection of periodic rehabilitation sites

Use this Template
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.

Related checklists

ITP-01-Traffic Management
NEMA Projects
ITP-01-Traffic Management
33 Downloads
ITP-04-Fill Construction
NEMA Projects
ITP-04-Fill Construction
27 Downloads
ITP-05-Install Drainage Culvert
NEMA Projects
ITP-05-Install Drainage Culvert
26 Downloads
ITP-03-Stabilisation
NEMA Projects
ITP-03-Stabilisation
24 Downloads
ITP-02-Pavement Layer
NEMA Projects
ITP-02-Pavement Layer
17 Downloads
Periodic Pavement Site Validation - Resurfacing
NEMA Projects
Periodic Pavement Site Validation - R...
3 Downloads
VNIE NSW Environmental Checklist
Matt McDermott
VNIE NSW Environmental Checklist
6 Downloads
back arrow for carousel
back arrow for carousel
iAuditor Logo Icon ©SafetyCulture 2022