Aerial Crossing Safety Assessment
Complete this assessment to evaluate the safety and compliance of aerial crossings at your site.
Site Location / Reference
*
Type of Aerial Crossing
*
Please Select
Overhead Power Line
Communication Cable
Pipeline
Other
Owner/Operator of Crossing
*
Crossing Height (meters)
*
What does the crossing pass over?
*
Roadway
Railway
Waterway
Pedestrian Path
Other
Visual Condition of Crossing
*
Good (no visible issues)
Fair (minor wear or damage)
Poor (major damage or hazard)
Are warning signs or markers present and visible?
*
Yes, clearly visible
Yes, but not clearly visible
No signs or markers
Nearby Hazards (select all that apply)
Trees or Vegetation
Construction Activity
Heavy Vehicle Traffic
None
Other
Risk Assessment Table
*
Rows
Likelihood (1=Rare, 5=Very Likely)
Consequence (1=Minor, 5=Severe)
Contact with Crossing
1
2
Crossing Failure
3
4
Signage Not Visible
5
6
Overall Safety Rating
*
1
2
3
4
5
Recommendations for Improvement
Assessor's Name
*
First Name
Last Name
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Assessment
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