ICE COVER INSPECTION TEMPLATE
Date: / Location:Completed by:
Climate Condition: Calm/Snow/Rain/Wind / List Names of Workers Present / 3)
Visibility Factors: Clear/Fog/Light/Dark / 1) / 4)
Today’s Temperature:______0 C / 2) / 5)
Ice Measurement Data / Traffic Control Record / Yes / No / If No a corrective action is required
Hole Distances Are Measured / AB Environment River Forecast
From the east/north to west/ south shore / Roadway is __ m - __ m width
Test Hole # / Ice Depth / Traffic Signs In Correct Position
#1- / cm / Traffic Signs Clean/Visible
#2- / cm / Barricades In Correct Position
#3- / cm / Test Holes—Staked & Numbered
#4- / cm / Ice Surface Clear of Snow
#5- / cm / Ice-Road Surface Visible
#6- / cm / Vehicles Cross @ Safe Speeds
#7- / cm / Vehicles Exceeding Load Ratings
#8- / cm / Unusual or Deep Cracks Starting
#9- / cm / Water Visible In Cracks
#10- / cm / Thin Ice On/Near Roadway
#11- / cm / Are Approach Ramps Sanded
#12- / cm / Sand/Salt Accumulating on Road
#13- / cm / Flooding Road Top Required
#14- / cm / Shore Inspection: Water On Surface—Shore Ice Lifting or Bulging—Shore Ice Falling or Dropping—Shore Ice Bulging/Breaking Up Stream—Water On Surface Up Stream
#15- / cm
#16- / cm / Ice Road Capacity Data (As per Alberta Ice Safety Best Practice…)
#17- / cm / Yesterday’s Load Capacity Rating: ______KG
#18- / cm
#19- / cm / Today’s Load Capacity Rating: ______KG
#20- / cm
#21- / cm / List Potential Problems Developing On Ice Road Or Up Stream:
#22- / cm
#23- / cm
#24- / cm
#25- / cm / List Name (s) of Persons Notified / List Time Of Notification
#26- / cm / 1) Project Manager / am/pm
#27- / cm / 2) Superintendent / am/pm
#28- / cm / 3) Supervisor / am/pm
#29- / cm / 4) AMA—Ice Road Load Capacity Changes / am/pm
#30- / cm / 5) / am/pm