Gatso T-Series Mobile Road Safety Camera

Camera Operator’s Supplementary Statement

Note: Do not use abbreviations in this form

Camera Operator:

Job No. : Site No. :

Session Start Time: hrs

Session Start Date:
(HH:MM)

Camera No: GTR Certification Expiry Date:

Location Description:
(Street, Road, Highway) (Suburb)

Between:

Camera Was Facing:* North South East West

*Tick Whichever is Applicable

While setting up the Road Safety Camera, I Omitted details/ Entered Details Incorrectly on the

Toughbook Databar Camera Operator Set-Up Notes

Incident Log Diagram Incident Log

The correct details should read:

Camera Operator Name

Date Camera Operator Signature

FORM-0596 Version: 1.2 Date: 15-JAN-2020