• Conducted on

  • Prepared by

  • Location


  • DBH (cm)

  • HEIGHT (m)

  • WIDTH (m)

  • Age Class

  • Photo of Tree in relation to site

  • Sketch of site plan


  • Branch Unions

  • Live Growth/ Canopy Cover

  • Deadwood %

  • Pest/ Disease Infestation

  • Has the tree been pruned for line clearance?

  • Epicormic Growth

  • Decay/ Bracket Fungi

  • Tree Stability

  • Photos


  • Wounds

  • Root Disturbance

  • Distance from driveway

  • Is this distance appropriate?

  • Is the tree causing damage?

  • Potential for Damage

  • Photos


  • Does the tree form part of an avenue

  • Does the tree have significance to the streetscape?

  • Is there clear vision?

  • Is pedestrian access clear?

  • Is vehicle access clear?

Risk Ananlysis

  • Chance of Failure

  • Consequence of Failure

  • Priority


  • Further Action

  • Are Contractors Required?

  • Estimated Time

  • Further Notes

  • Contact Method

  • Sign

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.