Information

  • Audit Title

  • Road
  • Start Location
  • Finish Location
  • Prepared by

  • Conducted on

Block Description

  • Road ID

  • Block ID

  • Extents of work

Road Condition

  • Rating

  • Cross Fall

  • Rideability

  • Surface Texture (Sand Patch Test)

  • Comments

Treatment

  • Select Treatment Type

  • Asphalt Type

  • Rejuvenation Treatment

Measurements

  • Length of Road (m)

  • Width of Road (m)

  • Variable Width (Cul-de-sac, Turn Out, Parking Lane, etc)

  • Edge Plane (m)

Driveways

  • Enter House Number(s)

  • Photo of Problem Driveway(s)

Road Sketch

  • Sketch Road and Defect Locations (Pavement, Drainage, Other, Etc)

  • Photo of sketch of Road and Defect Locations

Works Required (non pavement failure)

  • Arborist Required

  • Weed Spraying Required

  • Traffic Calming Device (Only if removal is required for treatment)

  • Special Line Marking (Yellow Lines, Green Bicycle Lanes, Bicycle Symbols, etc)

  • Special Line Marking (measurement and treatment type)

  • Shoulder Work

  • Traffic Light Loops (Number)

  • Service Lids to be Raised (number)

Road Failures 1

  • Type of Failure

  • Area (m2)

  • Photo of Failure

Road Failures 2

  • Type of Failure

  • Area (m2)

  • Photo of Failure

Road Failures 3

  • Type of Failure

  • Area (m2)

  • Photo of Failure

Road Failures 4

  • Type of Failure

  • Area (m2)

  • Photo of Failure

Road Failures 5

  • Type of Failure

  • Area (m2)

  • Photo of Failure

Road Failures 6

  • Type of Failure

  • Area (m2)

  • Photo of Failure

Road Failures 7

  • Type of Failure

  • Area (m2)

  • Photo of Failure

Road Failures 8

  • Type of Failure

  • Area (m2)

  • Photo of Failure

Road Failures 9

  • Type of Failure

  • Area (m2)

  • Photo of Failure

Road Failures 10

  • Type of Failure

  • Area (m2)

  • Photo of Failure

Road Failures 11

  • Type of Failure

  • Area (m2)

  • Photo of Failure

Drainage Works 1

  • Type of Drainage Works Required

  • Length (m) or Description of Other

  • Photo of Drainage Works

Drainage Works 2

  • Type of Drainage Works Required

  • Length (m) or Description of Other

  • Photo of Drainage Works

Drainage Works 3

  • Type of Drainage Works Required

  • Length (m) or Description of Other

  • Photo of Drainage Works

Drainage Works 4

  • Type of Drainage Works Required

  • Length (m) or Description of Other

  • Photo of Drainage Works

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.