Safety Assessment for Roadworks

Safety Assessment for Roadworks
Use this form to evaluate roadworks site safety, identify hazards, and record required actions before work proceeds.
Site and Project Details
Project/Site Name
Work Location / Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Date of Assessment
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Time of Assessment
Hour Minutes
AM/PM Option
Assessing Person or Team Name
First NameMiddle NameLast Name
Contractor / Company Name
Work Type / Roadworks Activity Category
Other
Roadworks Safety Assessment
Overall site safety readiness

1
2
3
4
5
6
7
8
9
10
1 is Not ready, 10 is Fully ready
Overall risk level

Hazard and control assessment

Traffic management effectiveness
Signage and visibility effectiveness
Pedestrian routing effectiveness
Barricades and barriers effectiveness
Emergency access effectiveness
Issues, Actions, and Follow-up
Identified hazards or non-conformities
Immediate actions required
Responsible person
First NameMiddle NameLast Name
Target completion date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Work status / decision
Assessor comments
Should be Empty:

Select theme: