Information

  • Client / Site

  • Conducted on

  • Prepared by

  • Document No.

  • Personnel

  • Location
  • Road to be assessed

  • Road
  • Road name

  • Width?

  • Shoulder width?

  • Street furniture

  • Type of street furniture?

  • Take photo

  • Overhead power lines crossing the road

  • NOTE: Ergonomic must be contacted for input and assessment

  • Chainage location?

  • Take photo

  • Comments

  • Traffic lights?

  • Take photo

  • Comments

  • Street lights?

  • Sufficient height to allow movement?

  • Take photo

  • Comments

Signoff

  • Officers name

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.