Title Page

  • Site

  • STMS Name/No.

  • Mobile

  • TM Company

  • Contractor

  • Date

  • Road Level

  • Location

General Information

  • WAP Ref.

  • Activity


  • A1. Missing

  • A2. Position

  • A3. Not visible/Fallen Over

  • A4. Wrong Sign

  • A5. Condition Unacceptable

  • A6. Permanent Sign

  • A7. Unapproved Sign Used/Too Small

  • A8. Non-compliant support/Sign too low

Mobile/Semi Static

  • B1. Tail pilot vehicle/AWVMS omitted or incorrect location

  • B2. Lead pilot vehicle omitted or incorrect location

  • B3. Shadow vehicle omitted or incorrect location

  • B4. TMA missing or non-compliant

  • B5. AWVMS/arrowboard non-compliant


  • C1. Inadequate provision of pedestrians

  • C2. Inadequate provision of cyclists


  • D1. Missing or ineffective taper

  • D2. Tapers too short

  • D3. Taper too short or missing

  • D4. Spacing in taper

  • D5. Spacing along lanes

  • D6. Missing or ineffective delineation along lanes

  • D7. Condition unacceptable

  • D8. Using non-approved device

  • D9. Road marking incorrect at long term level 2 or 3 roads

  • D10. Inadequate/missing site access


  • E1. Working in live lanes

  • E2. Missing or ineffective controller

  • E3. Safety zone compromised

  • E4. High visibility garment not acceptable

  • E5. Marginal surface condition (carriageway only)

  • E6. Unacceptable surface condition (peds, cyclists or carriageway)

  • E7. Barrier defects (missing or incorrect components)

  • E8. Unsafe of redundant TTM

  • E9. VMS message incorrect/inappropriate

  • E10. Flashing beacons/indicator lights not used or ineffective

  • E11. Parking/stopping features not relocated

  • E12. Unsafe and illegal parking of plant/equipment

  • E13. Marginal items (signs, delineators, Hi Vis garments)

Other Worksite Aspects

  • G1. Qualified person on site (refer to A5 of CoPTTM)

  • G2. TSL appropriate (refer to C4 of CoPTTM)

  • G3. Road user flow acceptable

  • G4. On-site Record (form must include STMS hourly checks and TSL details)

  • G5. TMP approved?

  • G6. Approved TMP sighted?

Final Result

  • Score Rating

Additional Details

  • General comments/Recommendations


  • Completed By : (Name & Signature)

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