Title Page

SITE DETAILS

  • Street Name

  • Work Type

  • Contract Coordinator

  • Service Provider

  • Job Number

  • Select date

SITE COORDINATION

  • Bus routes and bus lane in the works area?

  • Traffic lights loops affected by the works?

  • Overhead wires in the works area?

  • DBYD conducted?

  • Plant drop off location to be identified?

  • Any CWO works in the area?

  • Before photos taken?

  • Any heritage issues identified?

  • Service pit lids adjustment required?

  • Risk Management Worksheet required?

  • ROL required?

  • Line marking survey required?

  • Night works required?

  • VMS required?

  • Dilapidation report required?

  • Tree pruning/roots required?

  • Car share affected?

  • Site Coordination Actions?

COMMUNITY

  • Hotel, Major business affected?

  • School area near?

  • Police, Fire or Ambulance affected?

  • Notification letter required

  • 4 Weeks Notification

  • 2 Weeks Notification

  • 1 Week Notification

  • Community Actions?

OTHER NOTES

AUTHORISATION

  • City Representative

  • Service Provider Representative

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.