Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Select date

Location/Building:

Inspected By:

Zone:

  • Zone 1

  • Zone 2

  • Zone 3

  • Zone 4

  • Zone 5

Priority:

  • Priority 1

  • Priority 2

  • Priority 3

Streets/Buildings/Fire Lanes/Ranges

  • Is the surface are visible and a skid free surface attained the length and width of the designated surface?

  • Are intersections clear for vehicle access and visibility?

  • Are storm drains clear?

  • Are snow piles pushed away from the front of structures, facilities, equipment, or placed so as to not block or hinder government access to buildings and utilities?

  • Are Fire Department Connections clear and accessible?

  • Have all deficiencies and areas that need attention been reported?

Current Condition:

  • Complete

  • In-Progress

  • Moderate

  • Limited

  • Complete= Street is clear of snow & ice to 100% of standard In-Progress= Street is currently being worked on active schedule Moderate= Street is clear of snow & ice to 80-95% of standard Limited= Street is clear of snow & ice to 60% of standard

Parking Lots

  • Are handicap spaces accessible?

  • Is there a clear pass at the entrance way free of allocated snow?

  • Is there a clear pass at the exit way free of allocated snow?

  • Is snow cleared within a maximum of six inches away from the dumpsters in areas for access by solid waste contractor?

  • Have all deficiencies and areas that need attention been reported?

Current Condition:

  • Complete

  • In-Progress

  • Moderate

  • Limited

  • Complete= Parking lot is clear of snow & ice to 100% of standard In-Progress= Parking lot is currently being worked on active schedule Moderate= Parking lot is clear of snow & ice to 80-95% of accessibility Limited= Parking lot is clear of snow & ice to 60% of accessibility

Comments:

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