TMP Docket

• Docket No. (use job number)

• Client:

• Conducted on

  Date

• Prepared by

• Job Site
  Address

Road and Conditions

• Road Type and Configuration:

  Select 2-Way Multi Lane Divided Multi Lane Undivided Straight Hilly Curve Roundabout 3 Way Intesection 4 Way Intesection Oneway Near Traffic Lights Gravel Road

  • 2-Way
  • Multi Lane Divided
  • Multi Lane Undivided
  • Straight
  • Hilly
  • Curve
  • Roundabout
  • 3 Way Intesection
  • 4 Way Intesection
  • Oneway
  • Near Traffic Lights
  • Gravel Road

• Work Method:

  Select Stop/Slow Lane Closure Shoulder Pedestrian Contra Flow Lateral Shift Detour Traffic Lights Hold and Release Moble

  • Stop/Slow
  • Lane Closure
  • Shoulder
  • Pedestrian
  • Contra Flow
  • Lateral Shift
  • Detour
  • Traffic Lights
  • Hold and Release
  • Moble

• Weather:

  Select Fine Rain Overcast Sunny Hot Cold Frost Dust

  • Fine
  • Rain
  • Overcast
  • Sunny
  • Hot
  • Cold
  • Frost
  • Dust

• Visibility:

  Select Good Fair Poor Clear Dust/Fog Night

  • Good
  • Fair
  • Poor
  • Clear
  • Dust/Fog
  • Night

SWMS

• What version of the TMP SWMS are you using?

SWMS Sign On:

Traffic Controller

• I confirm that this Safe Work Method Statement has been explained to me and that I understand its contents.

  Sign

• Traffic Control Licence

  Media

• Level Two

  Media

• White Card

  Media

Additional Risk Assessment

• Are there additional hazards that fall outside the TMP SWMS

  Yes

  No

  N/A

Installed Signs

• Activities or Hazards

• Potential hazard/ Risk identified

• The lower the number the higher the risk. Select the Risk Rating before controls

• Control measures implemented

• The lower the number the higher the risk. Select the Risk Rating after controls. Do not commence work unless 3 or higher.

• Primary Road Name
  Address

• Landmark and Distance to the first sign:

• What signs are installed for the primary approach

  Select Road Work Ahead 60 80 100 Reduce Speed Worker Symbolic 40 Reduce Speed 1 Traffic Control Symbolic Prepare to Stop Do not over take Lane Status Merge Right Merge Left Road Work Ahead 1km Truck Turning Traffic Lights Ahead Traffic Light Symbolic Giveway Ahead Giveway No Overtaking 70 Worker Symbolic 1

  • Road Work Ahead
  • 60
  • 80
  • 100
  • Reduce Speed
  • Worker Symbolic
  • 40
  • Reduce Speed 1
  • Traffic Control Symbolic
  • Prepare to Stop
  • Do not over take
  • Lane Status
  • Merge Right
  • Merge Left
  • Road Work Ahead 1km
  • Truck Turning
  • Traffic Lights Ahead
  • Traffic Light Symbolic
  • Giveway Ahead
  • Giveway
  • No Overtaking
  • 70
  • Worker Symbolic 1

• What signs are installed for the secondary approach

  Select Road Work Ahead 60 80 100 Reduce Speed Worker Symbolic 40 Reduce Speed 1 Traffic Control Symbolic Prepare to Stop Do not over take Lane Status Merge Right Merge Left Road Work Ahead 1km Truck Turning Traffic Lights Ahead Traffic Light Symbolic Giveway Ahead Giveway No Overtaking 70 Worker Symbolic 1

  • Road Work Ahead
  • 60
  • 80
  • 100
  • Reduce Speed
  • Worker Symbolic
  • 40
  • Reduce Speed 1
  • Traffic Control Symbolic
  • Prepare to Stop
  • Do not over take
  • Lane Status
  • Merge Right
  • Merge Left
  • Road Work Ahead 1km
  • Truck Turning
  • Traffic Lights Ahead
  • Traffic Light Symbolic
  • Giveway Ahead
  • Giveway
  • No Overtaking
  • 70
  • Worker Symbolic 1

• Are there Pedestrian Signs Installed

  Yes

  No

  N/A

• Installed Signs

  Select Foot Path Closed Use Other Footpath Pedestrian > < Pedestrian

  • Foot Path Closed
  • Use Other Footpath
  • Pedestrian >
  • < Pedestrian

• Is there a detour

  Yes

  No

  N/A

• Installed Signs

  Select Detour Ahead Detours left Detours Right End Detour Local Traffic Only Road Closed Road Closed Ahead Road Work Ahead 80 60 End Road Works Drive Safely

  • Detour Ahead
  • Detours left
  • Detours Right
  • End Detour
  • Local Traffic Only
  • Road Closed
  • Road Closed Ahead
  • Road Work Ahead
  • 80
  • 60
  • End Road Works
  • Drive Safely
Side Road
• Side Road Name
  Address

• Installed Signage

  Select Yes No N/A

  • Yes
  • No
  • N/A

• What is the Taper length

• How many hazard markers used.

• What are the Termination Signs

  Select End Road Works Drive Safely End 60 End 40 50 60 70 80 90 100

  • End Road Works
  • Drive Safely
  • End 60
  • End 40
  • 50
  • 60
  • 70
  • 80
  • 90
  • 100

Times

Traffic Controller

• Designation

  Driver

  Straight to Site

• Travel Start

  Date

• Job Start

  Date

• Break Start

  Date

• Break Finish

  Date

• Job Finish

  Date

• Travel Finish

  Date

Overnight Signage

• Did any equipment get lost or broken on this site.

  Yes

  No

  N/A

• List the Signs:

• Was any Overnight Signage Left On Site

  Yes

  No

  N/A

• List the Signs:

Authorisation

• Signature:

  Sign

• Did the Traffic Controllers receive a break.

  Yes

  No

  N/A

• I confirm that the traffic controllers did not receive a break

  Sign