Information

  • Document No.

  • Road Name

  • Conducted on

  • Prepared by

  • Location
  • Testing conditions: Ensure testing is performed on dry, mainly horizontal surface with wind under 19km/hr

Road Surface Condition

  • Enter number of different seal surfaces

  • Road length

  • Other Information

Seal Surface 1

  • Photo of Seal Surface 1

  • Enter Chainage (or physical description)

  • Enter length

  • Enter width

  • Sand Patch Test 1 Location

  • Sand Patch Test 1 Result

  • Sand Patch Test 2 Location

  • Sand Patch Test 2 Result

  • Sand Patch Test 3 Location

  • Sand Patch Test 3 Result

Seal Surface 2

  • Photo of Seal Surface 2

  • Enter Chainage (or physical description)

  • Enter length

  • Enter width

  • Sand Patch Test 1 Location

  • Sand Patch Test 1 Result

  • Sand Patch Test 2 Location

  • Sand Patch Test 2 Result

  • Sand Patch Test 3 Location

  • Sand Patch Test 3 Result

Seal Surface 3

  • Photo of Seal Surface 3

  • Enter Chainage (or physical description)

  • Enter length

  • Enter width

  • Sand Patch Test 1 Location

  • Sand Patch Test 1 Result

  • Sand Patch Test 2 Location

  • Sand Patch Test 2 Result

  • Sand Patch Test 3 Location

  • Sand Patch Test 3 Result

Seal Surface 4

  • Photo of Seal Surface 4

  • Enter Chainage (or physical description)

  • Enter length

  • Enter width

  • Sand Patch Test 1 Location

  • Sand Patch Test 1 Result

  • Sand Patch Test 2 Location

  • Sand Patch Test 2 Result

  • Sand Patch Test 3 Location

  • Sand Patch Test 3 Result

Seal Surface 5

  • Photo of Seal Surface 5

  • Enter Chainage (or physical description)

  • Enter length

  • Enter width

  • Sand Patch Test 1 Location

  • Sand Patch Test 1 Result

  • Sand Patch Test 2 Location

  • Sand Patch Test 2 Result

  • Sand Patch Test 3 Location

  • Sand Patch Test 3 Result

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.