Title: Traffic Diversion Plan Registration Form

1.0 General

Project ID
TDP register number
(to be completed by the TDP team)

Date of Submission
Ashghal Representative

2.0 Project Details

Project Name
Location Zone Number
Road(s) Affected
Proposed Start Date
Proposed End Date
Description of Work
Client

3.0 Consultancy/Contractor Details (or attach business card)

Consultancy
Consultants Representative
Telephone Mobile
Email
Contractor
Contractors Representative
Telephone Mobile
Email

4.0 Site Traffic Management Supervisor (STMS) Details

STMS Name
Telephone Mobile

Rev: 00 Date: August 2013 Ref: AA-CSF-034 Page 1 of 4

UNCONTROLLED IF COPIED OR PRINTED
Email

Please provide details of sub-contractors on a separate sheet.

5.0 Nominated Independent WZ Road Safety Auditor Details

Company
Auditor (including
accreditation details)
Telephone Mobile
Email

6.0 Site Details

Road Type (single, Traffic Flow (vehicles

divided, number of lanes) per hour)
Temporary Speed
Limit Proposed (Y/N)?
Speed limit (km/h) If yes, what is the
proposed speed limit
(km/h)
Diversion route(s)
Hours when works to be required (Y/N)? If yes,
carried out (e.g. include plan showing
overnight working day) routes and proposed
signing
Provisions for
List of Stakeholders
pedestrians and local
attached (Y/N)? If no,
access (Y/N)? If no,
provide justification
provide justification

7.0 Program of Inspections

Inspection Responsibility Proposed Frequency

WZTM Safety Inspection Contract Supervisor
WZTM Safety Review Contract Supervisor

Rev: 00 Date: August 2013 Ref: AA-CSF-034 Page 2 of 4

UNCONTROLLED IF COPIED OR PRINTED
WZTM Process Review Contract Supervisor
WZTM Safety Audit Approvals Body Representative

8.0 Traffic Management Drawing(s)

Drawing Number Drawing Title Comments

9.0 Implementation Plan

Document Reference Document Title Comments

10.0 Clearance Plan

Document Reference Document Title Comments

11.0 Other Documents Attached

Document Reference Document Title Comments

Rev: 00 Date: August 2013 Ref: AA-CSF-034 Page 3 of 4

UNCONTROLLED IF COPIED OR PRINTED
Rev: 00 Date: August 2013 Ref: AA-CSF-034 Page 4 of 4
UNCONTROLLED IF COPIED OR PRINTED