TMP Survey

• Division

• Store Name and Number

• Photo of Store

  Media
• Location
  Address

• Conducted on

  Date

• Prepared by

• Consulted with

• WLG Traffic Management Survey. December 2013. Version 3.

External

Unloading

• Does the truck unload in an area that does not impact a road used by general traffic?

  Yes

  No

  N/A

• Does the truck unload in an area that does not effect the drive thru?

  Yes

  No

  N/A

• Does the store have multiple unloading scenarios? (Include peak trading times)

  Yes

  No

  N/A

Environment

• Is the drive thru being used as an entrance to the venue, car park or similar?

  Yes

  No

  N/A

• Are the unloading scenarios clear of speed humps, raised pavements or corners to slow traffic?

  Yes

  No

  N/A

Signage

• Are speed limit signs posted?

  Yes

  No

  N/A

• Are "Forklift in Use" signage displayed externally?

  Yes

  No

  N/A

• Does the signage meet Australian Standard, AS 1319?

  Yes

  No

  N/A

• Is the height maker clearly defined on the canopy?

  Yes

  No

  N/A

Manual Handling Equipment

• What type of Manual Handling Equipment is the store using?

  Select Manual Pallet Jack Electric Pallet Jack Forklift Yellow Trolley Lift 6 Wheeler Trolley Walkie Stacker None

  • Manual Pallet Jack
  • Electric Pallet Jack
  • Forklift
  • Yellow Trolley Lift
  • 6 Wheeler Trolley
  • Walkie Stacker
  • None

Forklift

• Are seat belts worn and in good condition?

  Yes

  No

  N/A

• Are the keys isolated?

  Yes

  No

  N/A

• Is the authorised forklift user supplied with a high visibility vest when operating the forklift?

  Yes

  No

  N/A

• Is the forklift being utilised for lifting stock or equipment and only for this purpose? <br>No person/people are aloud to be lifted with the forklift at any time.

  Yes

  No

  N/A

Forklift, Walkie Stacker, Electric Pallet Jack, Manual Pallet Jack and Yellow Lift Trolley

• Are operators trained before using Equipment?

  Yes

  No

  N/A

• Has the pre use inspection been completed prior to using the Forklift and/or Electric Pallet Jack?

  Yes

  No

  N/A

• Is there a list of authorised users displayed on the Forklift and/or Electric Pallet Jack?

  Yes

  No

  N/A

• Does any of the equipment appear faulty?

  Yes

  No

  N/A

Traffic Management Plan

• Is there currently a TMP in place?

  Yes

  No

  N/A

• Does the TMP highlight isolating the unloading area?

  Yes

  No

  N/A

• Does the TMP clearly demonstrate safety zones for pedestrians and/or truck drivers?

  Yes

  No

  N/A

• Are truck drivers aware of the TMP?

  Yes

  No

  N/A

P.P.E and Equipment

• Does the site have high visibility vests available that are in good condition and meet Australian Standards? <br>Vests must also contain reflector stripes for night vision. If no, how many vests does the store require?

  Yes

  No

  N/A

• Is the site using safety cones/barriers and chain to isolate the pedestrian exclusion zone?<br>Safety cones must be above 1 metre in height, have a reflective strip and are positioned 4 metres apart

  Yes

  No

  N/A

• Has the site been equipped with enough Safety Cones/Barriers to support theTMP? If no, how many are required?

  Yes

  No

  N/A

• Does the store have enough chain? If no, how many metres is required?

  Yes

  No

  N/A

Staff Awareness

• Are staff aware of the Traffic Management Plan?

  Yes

  No

  N/A

• Has the "TMP staff sign off " been completed?

  Yes

  No

  N/A

• Is the traffic management plan accessible to all staff?

  Yes

  No

  N/A

Action Plan

• Action 1

• Assigned to

• Due Date

  Date

• Action 2

• Assigned to

• Due Date

  Date

• Action 3

• Assigned to

• Due Date

  Date

• Action 4

• Assigned to

• Due Date

  Date

• Action 5

• Assigned to

• Due Date

  Date

• Action 6

• Assigned to

• Due Date

  Date

• Action 7

• Assigned to

• Due Date

  Date

• Action 8

• Assigned to

• Due Date

  Date

• Action 9

• Assigned to

• Due Date

  Date

• Action 10

• Assigned to

• Due Date

  Date