Street name(s) and number (from/to)
Address
RCA permit reference
Attended/Unattended
Principal: Chorus - Visionstream
Employer of site STMS
Audit commences
Date
Rating: A = Acceptable NI = Needs Improvement D = Dangerous
SUMMARY OF STANDARDS
STMS Name and Registration Number
1. Responsible Party<br>STMS/TC at attended site?
Acceptable
Needs Improvement
Dangerous
2. TMP
On site?
Appropriate to situation?
Acceptable
Needs Improvement
Dangerous
3. High-visibility garments
Worn by all?
Done up?
Condition acceptable?
Acceptable
Needs Improvement
Dangerous
4. Signs
All necessary signs present?
Acceptable
Needs Improvement
Dangerous
Correct positions?
Acceptable
Needs Improvement
Dangerous
Sand bagged for expected wind?
Acceptable
Needs Improvement
Dangerous
Conflicting signs covered?
Acceptable
Needs Improvement
Dangerous
Signs in good condition?
Acceptable
Needs Improvement
Dangerous
If other - please note:
Other?
Acceptable
Needs Improvement
Dangerous
5. Delineation
Protects working space/other features?
Acceptable
Needs Improvement
Dangerous
Taper lengths compliant?
Acceptable
Needs Improvement
Dangerous
Correct spacing of cones?
Acceptable
Needs Improvement
Dangerous
Sufficient positive traffic control?
Acceptable
Needs Improvement
Dangerous
If other - please note:
Other?
Acceptable
Needs Improvement
Dangerous
6. Pedestrian needs
All necessary signs present?
Acceptable
Needs Improvement
Dangerous
Footpath widths OK?
Acceptable
Needs Improvement
Dangerous
Safe passage for pedestrians?
Acceptable
Needs Improvement
Dangerous
Surface/ramps OK?
Acceptable
Needs Improvement
Dangerous
If other - please note:
Other:
Acceptable
Needs Improvement
Dangerous
7. Cyclist needs
Cycle widths OK?
Acceptable
Needs Improvement
Dangerous
Safe passage for cyclists?
Acceptable
Needs Improvement
Dangerous
Surfaces OK?
Acceptable
Needs Improvement
Dangerous
If other - please note:
Other:
Acceptable
Needs Improvement
Dangerous
8. Traffic needs
Lane widths OK?
Acceptable
Needs Improvement
Dangerous
Speed limit appropriate?
Acceptable
Needs Improvement
Dangerous
No significant delays?
Acceptable
Needs Improvement
Dangerous
Surfaces OK?
Acceptable
Needs Improvement
Dangerous
If other - please note:
Other?
Acceptable
Needs Improvement
Dangerous
9. Property access
Property access OK?
Acceptable
Needs Improvement
Dangerous
Number of Acceptable ratings:
Number of Needs Improvement ratings:
Number of Dangerous rating:
Action agreed by STMS/TC
Auditor
Auditor signature
Sign
STMS/TC signature
Sign
Audit finished
Date
link copied
Mel Dawson
Visionstream Site Condition Rating form (short form)
Online version of the COPTTM 4th Edition Site Condition Rating Form. Section E, Appendix C, Procedures for safety audit of worksites
The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions.
The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice.
You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction.
You should independently determine whether the template is suitable for your circumstances.