Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
REFERENCES
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Street names(s)
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Number (from / to)
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RCA permit reference
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Principal
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Employer of site STMS
1. RESPONSIBLE PARTY
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STMS / TC at attended site
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STMS / TC Name
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STMS / TC Registration number
2. TMP
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On Site
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Appropriate to situation
3. HIGH-VISIBILITY GARMENTS
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Worn by all
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Done up
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Condition acceptable
4. SIGNS
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All necessary signs present
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Correct positions
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Sand bagged for expected wind
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Conflicting signs covered
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Signs in good condition
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Other
5. DELINEATION
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Protects workers space / others features
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Taper lengths compliant
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Correct spacing of cones
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Sufficient positive traffic control
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Other
6. PEDESTRIAN NEEDS
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Footpath widths OK
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Safe passage for pedestrians
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Surfaces / ramps OK
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Other
7. CYCLIST NEEDS
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Cycle widths OK
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Safe passage for cyclists
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Surfaces OK
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Other
8. TRAFFIC NEEDS
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Lane widths OK
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Speed limit appropriate
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No significant delays
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Surfaces OK
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Other
9. PROPERTY ACCESS
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Property access OK
10. SITE SCORES
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Number in each rating
ACTION AGREED BY STMS / TC
AUDITOR
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Name
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Warrant Number
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Signature
STMS / TC
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Signature
