TTM SITE CONDITION RATING FORM - ATMS

• Where is the site`
  Address

• What is the site`

  Select

• RCA

  Select CDC LHCC MDC Waka Kotahi PCC SWDC UHCC WCC

  • CDC
  • LHCC
  • MDC
  • Waka Kotahi
  • PCC
  • SWDC
  • UHCC
  • WCC

• Suburb

  Select Carterton Clareville Featherston Greytown Haywards Horokiwi Johnsonville Kapiti Expressway Levin Lower Hutt Mackays Manakau Masterton Moonshine Ngauranga Ohau Otaki Paremata Peka Peka Petone Plimmerton Porirua Pukerua Bay Paekakariki Raumati Silverstream Tawa Upper Hutt Waikanae Wellington Whitford Brown

  • Carterton
  • Clareville
  • Featherston
  • Greytown
  • Haywards
  • Horokiwi
  • Johnsonville
  • Kapiti Expressway
  • Levin
  • Lower Hutt
  • Mackays
  • Manakau
  • Masterton
  • Moonshine
  • Ngauranga
  • Ohau
  • Otaki
  • Paremata
  • Peka Peka
  • Petone
  • Plimmerton
  • Porirua
  • Pukerua Bay
  • Paekakariki
  • Raumati
  • Silverstream
  • Tawa
  • Upper Hutt
  • Waikanae
  • Wellington
  • Whitford Brown

• Road name

• Activity Description

• TTM Contractor

  Select ATMS Capital Journeys CPB HEB Downer EMS FH Traffic Control G & C Diggers Higgins ITC Men At Work N/A PEL Contractors Pope and Gray PTS Recreational Services TMNZ TMNZ - Palmerston North Tplans Traffic Assist Trafficsafe Treescape Wellington Water WTA FHTC WTA ATMS WTA Downer WTA Men at Work WTA PTS WTA TMNZ WTA Higgins

  • ATMS
  • Capital Journeys
  • CPB HEB
  • Downer
  • EMS
  • FH Traffic Control
  • G & C Diggers
  • Higgins
  • ITC
  • Men At Work
  • N/A
  • PEL Contractors
  • Pope and Gray
  • PTS
  • Recreational Services
  • TMNZ
  • TMNZ - Palmerston North
  • Tplans
  • Traffic Assist
  • Trafficsafe
  • Treescape
  • Wellington Water
  • WTA FHTC
  • WTA ATMS
  • WTA Downer
  • WTA Men at Work
  • WTA PTS
  • WTA TMNZ
  • WTA Higgins

• TTM level

  LV

  1

  2

  2LS

  3

• CAR / WAP number

• WTA Works

  Yes

  No

• Date / Time

  Date

• Prepared by

  Jonah Passi

  Vena Lam Sam

  Jade Ng

  Mike Taylor Edwards

  Shaun Backman Playford

• Type of Audit/ Review Undertaken

  TTM

OPERATIONAL DETAILS

• TTM method

  Select Caution Only Contraflow Footpath Inspection Lane Mobile Mobile/Semi Static Road Closure with Diversion Rolling Block Semi-Static Shoulder Sideroad Closure Stop/Go Stop/Hold

  • Caution Only
  • Contraflow
  • Footpath
  • Inspection
  • Lane
  • Mobile
  • Mobile/Semi Static
  • Road Closure with Diversion
  • Rolling Block
  • Semi-Static
  • Shoulder
  • Sideroad Closure
  • Stop/Go
  • Stop/Hold

• Contractor - working space

  Select Broadspectrum Capital Journeys CDC Chorus CMP Coastlines CPB HEB Downer Fulton Hogan Griffiths Ground Works Higgins HTS Intergroup ITS/Downer Legacy Comms M2PP MDC Mills Albert N/A Northpower PP2O Recreational Services Road Safe SWDC Tascon TG Treescape Wellington Water WSP-Opus Abseil Access

  • Broadspectrum
  • Capital Journeys
  • CDC
  • Chorus
  • CMP
  • Coastlines
  • CPB HEB
  • Downer
  • Fulton Hogan
  • Griffiths
  • Ground Works
  • Higgins
  • HTS
  • Intergroup
  • ITS/Downer
  • Legacy Comms
  • M2PP
  • MDC
  • Mills Albert
  • N/A
  • Northpower
  • PP2O
  • Recreational Services
  • Road Safe
  • SWDC
  • Tascon
  • TG
  • Treescape
  • Wellington Water
  • WSP-Opus
  • Abseil Access

• Client / Principal

  Select Capital Journeys CDC CPB HEB Electra Fulton Hogan HCC KCDC Kiwirail MDC NOC PCC Powerco Private SWDC Treescape UHCC Waka Kotahi NZTA WCC

  • Capital Journeys
  • CDC
  • CPB HEB
  • Electra
  • Fulton Hogan
  • HCC
  • KCDC
  • Kiwirail
  • MDC
  • NOC
  • PCC
  • Powerco
  • Private
  • SWDC
  • Treescape
  • UHCC
  • Waka Kotahi NZTA
  • WCC

SIGNS

• A1 Missing Signs 5 points per sign

  Select 5 points each 1 2 3 4 5 6 7 8

  • 5 points each
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8

• A2 Position 2 points per sign

  Select 2 points each 1 2 3 4 5 6 7 8

  • 2 points each
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8

• A3 Not visible / fallen over 5 points per sign

  Select 5 points each 1 2 3 4 5 6 7 8

  • 5 points each
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8

• A4 Wrong sign 5 points per sign

  Select 4 points each 1 2 3 4 5 6 7 8

  • 4 points each
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8

• A5 Condition unacceptable 4 points per sign

  Select 4 points each 1 2 3 4 5 6 7 8

  • 4 points each
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8

• A6 Permanent sign 5 points per sign

  Select 5 points each 1 2 3 4 5 6 7 8

  • 5 points each
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8

• A7 Unapproved sign used / too small 4 points per sign

  Select 4 points each 1 2 3 4 5 6 7 8

  • 4 points each
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8

• A8 Non-compliant support / sign too low 2 points per sign

  Select 2 points each 1 2 3 4 5 6 7 8

  • 2 points each
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8

MOBILE & SEMI STATIC

• B1 Tail pilot vehicle / AWVMS omitted or incorrect location <br>30 Points

  Pass

  Fail - 30 Points

  N/A

• B2 Lead pilot vehicle omitted or incorrect location <br>20 Points

  Pass

  Fail - 20 Points

  N/A

• B3 Shadow vehicle omitted or incorrect location <br>26 Points

  Pass

  Fail - 26 Points

  N/A

• B4 TMA missing or non compliant<br>26 Points

  Pass

  Fail - 26 Points

  N/A

• B5 AWVMS / arrowboard non compliant<br>26 Points

  Pass

  Fail - 26 Points

  N/A

PEDESTRIANS / CYCLISTS

• C1 Inadequate provision for pedestrians <br>10 Points

  Pass

  Fail - 10 points

  N/A

• C2 Inadequate provision for cyclists <br>10 Points

  Pass

  Fail - 10 points

  N/A

DELINEATION

• D1 Missing or ineffective taper – leading taper (including chicane) <br>26 Points

  Pass

  Fail - 26 Points

  N/A

• D2 Tapers too short – leading taper <br>15 points

  Pass

  Fail - 15 Points

  N/A

• D3 Taper too short or missing – trailing taper<br>5 Points

  Pass

  Fail - 5 Points

  N/A

• D4 Spacing in taper <br>5 points

  Pass

  Fail - 5 Points

  N/A

• D5 Spacing along lanes <br>3 points

  Pass

  Fail - 3 points

  N/A

• D6 Missing or ineffective delineation along lanes <br>10 Points

  Pass

  Fail - 10 points

  N/A

• D7 Condition unacceptable 2 Points each

  Select 2 points each 1 2 3 4 5 6 7 8

  • 2 points each
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8

• D8 Using non-approved device 4 Points

  Select 4 points each 1 2 3 4 5 6 7 8

  • 4 points each
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8

• D9 Road marking incorrect at long term level 2 or 3 roads <br>30 Points

  Pass

  Fail - 30 Points

  N/A

• D10 Inadequate / missing site access <br>10 points

  Pass

  Fail - 10 points

  N/A

MISCELLANEOUS

• E1 Working in live lanes 20 points per breach

  Select 20 points per breach 1 2 3 4 5

  • 20 points per breach
  • 1
  • 2
  • 3
  • 4
  • 5

• E2 Missing or ineffective controller 20 points per event

  Select 20 points per breach 1 2 3 4 5

  • 20 points per breach
  • 1
  • 2
  • 3
  • 4
  • 5

• E3 Safety zone compromised 10 points per breach

  Select 10 points per breach 1 2 3 4 5

  • 10 points per breach
  • 1
  • 2
  • 3
  • 4
  • 5

• E4 High visibility garment not acceptable 5 points each

  Select 5 points each 1 2 3 4 5 6 7 8

  • 5 points each
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8

• E5 Marginal surface condition (carriageway only) <br>15 points each

  Pass

  Fail - 15 Points

  N/A

• E6 Unacceptable surface condition (peds, cyclists or carriageway) <br>30 points

  Pass

  Fail - 30 Points

  N/A

• E7 Barrier defects (missing or Incorrect components) <br>10 points each

  Pass

  Fail 10 points

  NA

• E8 Unsafe or redundant TTM 5 points each

  Select 5 points each 1 2 3 4 5 6 7 8

  • 5 points each
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8

• E9 VMS message incorrect or inappropriate <br>15 points

  Pass

  Fail - 15 Points

  N/A

• E10 Flashing beacons / indicator lights not used or ineffective <br>3 points

  Pass

  Fail - 3 points

  N/A

• E11 Parking / stopping features not relocated 5 points each

  Select 5 points each 1 2 3 4 5 6 7 8

  • 5 points each
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8

• E12 Unsafe and illegal parking of plant / equipment <br>20 points

  Pass

  Fail - 20 Points

  N/A

• E13 Marginal items (signs, delineators, Hi vis garments) 1 point each

  Select 1 point each 1 2 3 4 5 6 7 8 9 10

  • 1 point each
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

OTHER WORKSITE ASPECTS

• G1 QUALIFIED PERSON ON SITE [REFER TO A5 OF COPTTM] <br><br>

  Pass

  Fail

  N/A

• GOOD SITE INDUCTION? [DOES NOT AFFECT SCORE]<br>

  Yes

  No

  N/A

• G2 TSL APPROPRIATE [REFER TO C4 OF COPTTM] <br><br>

  Pass

  Fail

  N/A

• G3 ROAD USER FLOW ACCEPTABLE <br><br>

  Pass

  Fail

  N/A

• G4 ON-SITE RECORD [FORM MUST INCLUDE STMS AUTHORITY, 2 HOURLY CHECKS AND TSL DETAILS] <br><br>

  Pass

  Fail

  N/A

• G5 TMP APPROVED?<br><br>

  Pass

  Fail

  N/A

• TMP Type?

  Site specific

  Generic

• G6 APPROVED TMP SIGHTED? <br><br>

  Pass

  Fail

  N/A

• G7 APPROVED TMP APPLICABLE? <br><br>

  Pass

  Fail

  N/A

• G8 TTM IN ACCORDANCE WITH APPROVED TMP? <br><br>

  Pass

  Fail

  N/A

ACTIONS PLANNED BY STMS

• SITE FIXED? <br><br>When a review identifies an unacceptable and / or dangerous site did the STMS cease the activity and go about making corrections in a timely manner to bring the site up to an acceptable standard prior to recommencing works? If No, a Stops Works Order will be considered. Note: Not all situations will require the physical works to be stopped while corrections are made to the TTM. Physical works must stop if they are contributing to the hazards identified. Consideration should be given to whether ceasing the works will create a greater hazard or the site will become more unsafe if the works stop. Consideration should also be given if corrections can be done in a timely manner and whether there is the ability to make the corrections or whether another party would be required to assist with the corrections.

  Yes

  No

  N/A

SITE ACTIVITY CEASED BY

• If the site activity has been ceased, indicate who directed that the work to cease.

  Select N / A STMS Auditor/reviewer Non-STMS RCA Rep Engineer Work Safe Police Fire Service Civil Defence

  • N / A
  • STMS
  • Auditor/reviewer
  • Non-STMS
  • RCA Rep
  • Engineer
  • Work Safe
  • Police
  • Fire Service
  • Civil Defence

• Select STMS

  Select Anthony Iosefa 99490 021 140 5561 Chris Tuimalealiifano 120728 021 022 02188 Fish Paipa 102068 022 469 0346 Jamie Matehaere 90665 027 215 5643 Jessie Brown 120731 021 459 394 Jonah Passi 98570 027 379 6313 Keelan Ng 135098 027 869 0622 Kevin Dagg 50234 027 683 2020 Kit Leota 88972 027 229 4754 Michael Bourne 114531 020 4116 0476 Mike Taylor-Edwards 28020 027 440 7376 Puna Siupolu 142595 027 525 4239 Qwintyn Bennett-Thomason 147049 021 172 5218 Shaun Backman-Playford 46539 022 478 4153 Sid Mabey Snr 68618 022 135 8736 Terry Tuiloma 67799 027 351 6793

  • Anthony Iosefa 99490 021 140 5561
  • Chris Tuimalealiifano 120728 021 022 02188
  • Fish Paipa 102068 022 469 0346
  • Jamie Matehaere 90665 027 215 5643
  • Jessie Brown 120731 021 459 394
  • Jonah Passi 98570 027 379 6313
  • Keelan Ng 135098 027 869 0622
  • Kevin Dagg 50234 027 683 2020
  • Kit Leota 88972 027 229 4754
  • Michael Bourne 114531 020 4116 0476
  • Mike Taylor-Edwards 28020 027 440 7376
  • Puna Siupolu 142595 027 525 4239
  • Qwintyn Bennett-Thomason 147049 021 172 5218
  • Shaun Backman-Playford 46539 022 478 4153
  • Sid Mabey Snr 68618 022 135 8736
  • Terry Tuiloma 67799 027 351 6793

KEY POINTS / AUDIT RESULTS

• Auditor/Reviewer notes areas identified in the review including both good aspects and areas for improvement.

• COMPLAINT CALLOUT? <br>Has the audit been triggered by a complaint?

  Yes

  No

  N/A

• SITE ACTIVITY STATUS <br>Is the site Attended or Unattended?

  Attended

  Unattended

• AUDIT/ REVIEW PLANNED / UNPLANNED?<br>Was this audit/review planned or unplanned (as in did you discover this site by chance or did you know it was here)? <br>

  Planned

  Unplanned

• NOTIFICATIONS (RCA) [DOES NOT AFFECT SCORE] <br>Evidence available of notification of work programme to RCA for TMP implementation, organisation responsible for traffic signals when affected, Public Transport for bus stop relocations. <br>

  Yes

  No

  N/A

• Has the RCA been notified of the intended dates and times of implementation and the STMS responsible?

  Yes

  No

  N/A

• Where applicable have public transport agencies been advised of any impact to bus routes, bus stops or bus parking locations?

  Yes

  No

  N/A

• Where traffic signals may be affected has the organisation responsible for the signals been notified of the intent to work near traffic signals?<br>Evidence available of notification of work programme to RCA for TMP implementation, organisation responsible for traffic signals when affected, Public Transport for bus stop relocations.

  Yes

  No

  N/A

• TMP DESIGN ISSUES? <br><br>Record issues relating to the TMP design or approval in key points field. These issues do not need to be addressed with the onsite STMS or delegate. These issues will need to be followed up after the audit with the designer or approver of the TMP.

  Yes

  No

  N/A

• If yes, record issues in key points below

• Record issues relating to the TMP design or approval in key points field. These issues do not need to be addressed with the onsite STMS or delegate. These issues will need to be followed up after the audit with the designer or approver of the TMP.

ACTIONS TO BE TAKEN

• Auditor/Reviewer notes actions to be taken to improve the condition and/or operation of the site. Where a site is identified as dangerous this must include areas that must be addressed prior to activities re-commencing. Corrections should be communicated and agreed between the relevant parties and recorded on the form so there is a clear understanding of any requirements, including timeframes for the various changes required and who is responsible for the changes.

  Select Notice of Improvement to be issued Stop Work Notice to be issued Notice of Non Conformance to be issued Site Fixed while Auditor on site

  • Notice of Improvement to be issued
  • Stop Work Notice to be issued
  • Notice of Non Conformance to be issued
  • Site Fixed while Auditor on site

AUDITOR / REVIEWER TO COMPLETE

• Auditor / Reviewer name:

  Drawing

• Auditor / Reviewer qualification NZTA ID No.

• Auditor / Reviewer mobile number:

• In submitting this form, the auditor / reviewer specified above agrees that they have explained the significant issues and proposed remedies to the relevant parties specified above and have handed these parties a physical copy of the audit (does not apply for unattended sites).
  

STMS TO COMPLETE

• Received by / Signed

  Sign

FINAL SCORE

• RATINGS

  Select High Standard - 0-10 points Acceptable - 11-25 points Needs Improvement - 26-50 points Unacceptable - 51+ points Unacceptable - Other DANGEROUS -51+ points and LOW RISK? is marked NO

  • High Standard - 0-10 points
  • Acceptable - 11-25 points
  • Needs Improvement - 26-50 points
  • Unacceptable - 51+ points
  • Unacceptable - Other
  • DANGEROUS -51+ points and LOW RISK? is marked NO

Score

• Final score

• Is the score due to safety concerns

  Yes

  No

  N/A

Site Photos

• Add media

  Media