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Inspection

General Information

WAP Ref.

Activity

Signs

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

Pedestrians/Cyclists

C1. Inadequate provision of pedestrians

C2. Inadequate provision of cyclists

Delineation

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

Miscellaneous

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

Completion
Completed By : (Name & Signature)

TAURANGA CITY COUNCIL - Site Condition Rating Form Checklist

Created by: SafetyCulture Staff | Industry: Local Government | Downloads: 4

Use this template to identify deficiencies and apply corrective action for compliance.

Signup for a free iAuditor account to download and edit this checklist. It will be added to your free account and you will be able to conduct inspections from your mobile device.

Download and edit this free checklist

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Inspection

General Information

WAP Ref.

Activity

Signs

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

Pedestrians/Cyclists

C1. Inadequate provision of pedestrians

C2. Inadequate provision of cyclists

Delineation

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

Miscellaneous

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

Completion
Completed By : (Name & Signature)