Track, Structures, Signals and Electrical Examination System Inspection/Defects Found Report Form

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(Optional - for use when printing books)

* Daily Summary of Inspections *Defects Found * Work Required * Labour & Material Resources Required * Work Done Work Group:
TYPE: TP - Track Patrol

Week Ending:
GI - General Track Inspection E - Engine

Name of Examiner:
Other TMP Inspection (specify - e.g. Detailed Track Inspection): KM TO DIR TRAVEL DATE SIGNATURE

TYPE

EQUIPMENT INSPECTED

KM FROM

EQUIPMENT IDENTIFICATION

DEFECT IDENTIFICATION

RECTIFICATION

ESTIMATE TO COMPLETE WORK

Defect Response Category

Target date or Date Repaired

Component

Size / UOM

Modifier

Equipment SPN or Ellipse Equipment Number

Km From

Km To

Date Found

Defect Type

Std Job No.

Priority

Action taken, proposed or requested (Scope of work)

List of materials, sizes, labour, no. of staff and other resources required to complete work

Note: All structures defects must be forwarded onto the local Structures Representative. Are there any additional or changes to Geotechnical Sites: Yes

No

If YES please list on Defect Report form above i.e. Rock fall, slips, etc

My signature confirms that I have examined the infrastructure as stated above to the best of my ability in accordance with Australian Rail Track Corporation Standards. At any location where there was found to be corrective work required, appropriate corrective action has been taken or necessary protection applied, and the work required has been recorded on this Report.

Signature: ....................................................................

Date: ...........................

Form number: EGP1001F-01 30 Jul 13; Version 1.0 This document is uncontrolled when printed