Rural Fixed Speed Sign Inspection Form

• Enter Work Order Number

• Site Code (Region)

  N/A

  Central (E2, E3, N4, N5, W1, W3, W5)

  North / East (E4, E7)

  South / East (E5, E6)

  West (W2, W4, W6)

• Which North / East Region

  E4

  E7

• Which South / East Region

  E5

  E6

• Which West Region

  W2

  W4

  W6

• Which Central Region

  Select E2 E3 N4 N5 W1 W3 W5

  • E2
  • E3
  • N4
  • N5
  • W1
  • W3
  • W5
• GPS Coordinates
  Address
• Street Name: e.g. Great Ocean Road
  Address

• Suburb

• Site Description: e.g. Great Ocean Rd, 1 km Nth of Lorne, Northbound Traffic

• Melway / Vicroads Ref:

• Time of Arrival

  Date

• Drive site and locate correct speed sign

  Yes

  No

• Speed sign states "HIGH RISK AREA - POLICE ENFORCING SPEED"

  Yes

  No

Park vehicle safely (Tyres to be left of the Fog Line) Vehicle may be parked part bitumen or gravel and grass No parking in the Emergency Lane on Freeway

• Vehicle off road

  Yes

  No

• Beacon activated

  Yes

  No

• Duration < 20 minutes

  Yes

  No

• Traffic Management Plan" required

• Welfare sent to OSC (Site Arrival)

  Yes

  No

• Section A completed

  Yes

  No

• GPS Coordinates match Section A

  Yes

  No
• New Coordinates
  Address

• Melway / Vicroads coordinates correct

  Yes

  No

• New Reference

Road Type

• Carriage

  Single Lane

  Dual Lane

• Surface

  Sealed

  Unsealed

  Pavement

  Median Strip

• Comments

Vehicle Parking

• Site condition

  Select Clean Litter / Debris Vegitation

  • Clean
  • Litter / Debris
  • Vegitation

• Comments

• Position

  On Raod

  Off Road

• Safety

  Safe

  Unsafe

• Comments

Signs

• Reflective Properties

  Visible

  Not Visible

• Sign Physically Present

  Yes

  No

• Evidence

  Sign Previously Existed

  No evidence of previos

• Comments

• Number Signs Present

  1

  2

  3

  4

  5

• Sign 1 Facing

  North

  South

  East

  West

• Sign 2 Facing

  North

  South

  East

  West

• Sign 3 Facing

  North

  South

  East

  West

• Sign 4 Facing

  North

  South

  East

  West

• Sign 5 Facing

  North

  South

  East

  West

• Orientation

  Landscape

  Portrait

Physical Condition

• Sign

  Select Good Paint Chipped / Peeling Rust Holes Graffiti

  • Good
  • Paint Chipped / Peeling
  • Rust
  • Holes
  • Graffiti

• Poles

  Good

  Left Damaged

  Right Damaged

  Both Damaged

• Description of damage

• Repair Required

  No

  Yes

• Side

  Front

  Back

  Both

• Location

  Select Right Top Left Bottom

  • Right
  • Top
  • Left
  • Bottom

• Comments

• Dirt on Sign

  Yes

  No

• Asset label fixed to bottom left hand corner of sign

  Yes

  No

• Comments

Site Safety and Photos

• Ladder required

  Yes

  No

• Ladder safely affixed

  Yes

  No

• Photo(s) of ladder setup

  Media

• Comments

• Photo(s) landscape view including surrounds

  Media

• Comments

• Photo(s) of area of sign depicting damage

  Media

• Comments

• Photo(s) of Asset Label on back of sign

  Media

• Comments

Check list

• Section A, B & C completed

  Yes

  No

• GPS Coordinates checked and confirmed

  Yes

  No

• Site photo(s) taken

  Yes

  No

• Asset label affixed

  Yes

  No

• Sign Damaged

  Yes

  No

Signature

• General Comments

• Name and Signature required

  Sign