Tree Site Information, Risk Assesment Form - duplicate

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Job Brief

Tree Site Information

• GPS Coordinates (copy/paste from a map app)

• Photo

  Media

Common Name

• Common Name

Species

• Species

Status

• Status Choices

  Select Established Removed Potential Planting Site

  • Established
  • Removed
  • Potential Planting Site

Setting

• Setting Choices

  Select Footpath Carpark Island Road Mall Park Embankment (waterway) Embankment (Road) Private

  • Footpath
  • Carpark
  • Island
  • Road
  • Mall
  • Park
  • Embankment (waterway)
  • Embankment (Road)
  • Private

Environment

• Environment Choices

  Select Bitumen Concrete Garden Grass Gravel Mulch Pavers Planter Grate Other Unknown

  • Bitumen
  • Concrete
  • Garden
  • Grass
  • Gravel
  • Mulch
  • Pavers
  • Planter
  • Grate
  • Other
  • Unknown

• Grate Style

  Select Hexagonal Allen Square Unknown None

  • Hexagonal
  • Allen
  • Square
  • Unknown
  • None

Tree Guards

• Tree Guards

  Yes

  No

Risk Assesment

• Size of Part Likely to Fail

  Select Over 751 mm 451 to 750 mm 151 to 450 mm 21 to 150 mm 1 to 20 mm

  • Over 751 mm
  • 451 to 750 mm
  • 151 to 450 mm
  • 21 to 150 mm
  • 1 to 20 mm

• Target Usage

  Select Constant-use Frequent- use Intermittent-use Occassional-use Low-use

  • Constant-use
  • Frequent- use
  • Intermittent-use
  • Occassional-use
  • Low-use

• Likelihood of Failure

  Select Failure Certain Failure Likely Failure Possible Failure Unlikely No Detectable Threats

  • Failure Certain
  • Failure Likely
  • Failure Possible
  • Failure Unlikely
  • No Detectable Threats

• Consequence of Failure

  Select Catastrophic Major Moderate Minor Insignificant

  • Catastrophic
  • Major
  • Moderate
  • Minor
  • Insignificant

• Score Given?

  Select 14 to 16 12 to 14 11 to 12 7 to 10 0 to 6

  • 14 to 16
  • 12 to 14
  • 11 to 12
  • 7 to 10
  • 0 to 6

• Situation Critical - immediate remedial work required as recommended below

• Photo if required

  Media

• Removal Required?

  Yes

  No

• Removal Size

  Select Xtra Large Removal Large Removal Small Removal Juvenile Removal

  • Xtra Large Removal
  • Large Removal
  • Small Removal
  • Juvenile Removal

• Situation Urgent - Immediate remedial work required within 5 working days