RESTRICTED ACCESS VEHICLE
ROUTE ASSESSMENT FORM
This form is to be used when completing any Restricted Access Vehicle (RAV) route assessment in
conjunction with the Standard RAV Route Assessment Guidelines, Tri Drive Route Assessment
Guidelines or Concessional Loading Route Assessment Guidelines. Please complete only those
sections relevant to the assessment type, additional information may be added as required.
Assessment Officer:
Name:
Name:
Position:
Position:
Employer:
Employer:
Phone:
Phone:
Date:
RAV Details:
Class:
Length:
m
Category:
Width:
m
Product/Restrictions:
Height:
m
Road Assessed:
Operator/LG Requesting:
Built Up area:
Road Name/Number:
LG No:
From:
To:
SLK From:
SLK To:
Distance:
Is this a school bus route?
Yes:
Office Use Only:
Reviewer Details:
Name:
Position:
Employer:
Phone:
Date:
Comments:
MAIN ROADS Western Australia
D16#72951 - RAV Route Assessment Form – August 2016
No:
Yes:
No:
Road Widths
1) The road is a:
Rural Road complete Table 1 ONLY.
Townsite Road complete Table 2 ONLY.
Comments:
Table 1 – Rural Road Width
Please answer the following
What is the AADT? (Daily Traffic Volumes)
Criteria
AADT
Road
Section 1
Road
Section 2
Road
Section 3
Road
Section 4
Road
Section 5
Sealed
Sealed
Sealed
Sealed
Sealed
Unsealed
Unsealed
Unsealed
Unsealed
Unsealed
Road Surface
Carriageway Width (m)
Sealed Width (m)
Length (km)
Posted Speed Limit
(km/h)
Sight Distance always
over 250m (for Low
volume roads Appendix C
or 2.4.5 Signage
considerations in the
Standard Guidelines)
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Office Use Only:
Minimum guideline
requirements for road widths:
Carriageway (m):
Seal (m):
Meets guideline requirements as per:
Appendix B at:
60 – 70 km/h
80 – 100km/h
Appendix C Low volume Type B Road
Appendix C Low volume Type A Road at:
40km/h
60km/h
Does NOT meet Guideline Requirements
Comments:
MAIN ROADS Western Australia
D16#72951 - RAV Route Assessment Form - August 2016
Page 2 of 22
Table 2 – Town Site Road Width
Please tick most appropriate
Undivided Carriageway
Undivided Carriageway
2 way
1 way
Undivided Carriageway
2 lanes each way
Divided Carriageway
Single lane
Divided Carriageway
2 lanes each way
Divided Carriageway
3 lanes each way
Please answer the following
What is the posted speed limit on the road?
Speed Limit (km/h)
What is the carriageway width?
(width measurement should be taken from the edge of
the seal to the road centre or edge of the median/traffic
island)
What is the shoulder width? (If applicaple)
Carriageway Width (m)
Shoulder Width (m)
Question
Comments
Is there designated cycle lanes?
Yes
No
Is there Parallel parking?
Yes
No
Yes
No
Yes
No
Yes
No
If yes are there designated parking bays?
Is there regular Angle parking?
If yes are there designated parking bays?
Office Use Only:
Minimum guideline requirements for road width (m):
Does the townsite road meet guideline requirements for width?
Yes
No
Comments:
MAIN ROADS Western Australia
D16#72951 - RAV Route Assessment Form - August 2016
Page 3 of 22
Please attach photos relevant to Road Widths
Location
Road Features
(Description)
Photo
Insert Photograph Here (additional boxes should be added as required)
MAIN ROADS Western Australia
D16#72951 - RAV Route Assessment Form - August 2016
Page 4 of 22
Road Alignment
Road Alignment
2) Have any significant curves/bends been identified on the
road?
Yes
No
If Yes, answer question 3
3) Are any of the following signs installed prior to
the bends?
Warning signs
Advisory speed signs
Comments:
Please attach photos relevant to Road Alignment
Location
Road Features
(Description)
Photo
Insert Photograph Here (additional boxes should be added as required)
MAIN ROADS Western Australia
D16#72951 - RAV Route Assessment Form - August 2016
Page 5 of 22
Grades
4) Have any gradients been identified?
Yes
No
If Yes complete Table 3 below:
Table 3 – Grades (ONLY list grades 3% or above for unsealed roads, 5% or above for sealed roads)
Criteria
Grade 1
Road Surface
Sealed
Unsealed
Grade 2
Sealed
Unsealed
Grade 3
Sealed
Unsealed
Grade 4
Sealed
Unsealed
Grade (%)
Length (m)
Office Use Only:
Minimum guideline requirements for grades (%):
Grade 1
Meets
Guidelines:
Yes
No
Grade 2
Yes
No
Grade 3
Yes
No
Grade 4
Yes
No
Comments:
Please attach photos relevant to Grades
Location
Road Features
(Description)
Photo
Insert Photograph Here (additional boxes should be added as required)
MAIN ROADS Western Australia
D16#72951 - RAV Route Assessment Form - August 2016
Page 6 of 22
OBSTACLES: Bridges, Culverts, Floodway’s, Overhead
Clearance and Railway Crossings
Bridges
5) Have any drive on bridges been identified?
Yes
No
If Yes, complete Table 4 below:
Table 4 - Bridges
Criteria
Bridge 1
Bridge 2
Bridge 3
Bridge 4
Structure Number
Surface
Sealed
Unsealed
Sealed
Unsealed
Sealed
Unsealed
Sealed
Unsealed
Yes
No
Yes
No
Yes
No
Yes
No
Width between kerbs
(m)
Central Line Marking
Sight Distance 1
and direction of travel
(m)
Sight Distance 2
and direction of travel
(m)
Office Use Only:
Minimum guideline requirements for width between kerbs (m):
Bridge 1
Meets Guidelines:
Yes
No
Bridge 2
Yes
No
Bridge 3
Yes
No
Have the bridges been assessed by structures engineering branch and found
suitable for RAV access?
Bridge 4
Yes
Yes
No
No
Comments:
MAIN ROADS Western Australia
D16#72951 - RAV Route Assessment Form - August 2016
Page 7 of 22
Please attach photos relevant to Bridges
Location
Road Features
(Description)
Photo
Insert Photograph Here (additional boxes should be added as required)
MAIN ROADS Western Australia
D16#72951 - RAV Route Assessment Form - August 2016
Page 8 of 22
Culverts
6) Have any culverts been identified?
Yes
No
7) Are there any culverts that may be an issue for RAVs?
Yes
No
N/A
(E.g. damage, no guide posts etc.)
For ANY culverts less than the road formation width, please complete Table 5 below.
Comments:
Table 5 - Culverts
Sight Distance 1 (m)
Location (km)
Width of Culvert (m)
(specify direction
E.g. north east = NE)
Sight Distance 2 (m)
(specify direction)
Direction:
Direction:
Direction:
Direction:
Direction:
Direction:
Direction:
Direction:
Office Use Only:
Comments:
Please attach photos relevant to Culverts
Location
Road Features
(Description)
Photo
Insert Photograph Here (additional boxes should be added as required)
MAIN ROADS Western Australia
D16#72951 - RAV Route Assessment Form - August 2016
Page 9 of 22
Floodway’s
8) Have any floodway’s been identified?
Yes
No
9) Are there any floodway’s that may be an issue for RAVs?
Yes
No
N/A
(E.g. damage, no guide posts etc.)
For ANY floodway’s less than the road formation width, please complete Table 6 below
Comments:
Table 6 - Floodway’s
Sight Distance 1 (m)
Location (km)
Width of Floodway (m)
(specify direction
E.g. north east = NE)
Sight Distance 2 (m)
(specify direction)
Direction:
Direction:
Direction:
Direction:
Direction:
Direction:
Direction:
Direction:
Office Use Only:
Comments:
Please attach photos relevant to Floodway’s
Location
Road Features
(Description)
Photo
Insert Photograph Here (additional boxes should be added as required)
MAIN ROADS Western Australia
D16#72951 - RAV Route Assessment Form - August 2016
Page 10 of 22
Overhead Clearance
10) Have any overhead obstructions been identified?
Yes
No
If Yes, complete Table 7 below:
Comments:
Table 7 – Overhead Clearance
Criteria
Overhead
Obstruction 1
Overhead
Obstruction 2
Overhead
Obstruction 3
Overhead
Obstruction 4
Obstruction 1
Obstruction 1
Obstruction 1
Obstruction 1
What is the overhead
obstruction?
(e.g. tree, bridge,
power line)
Minimum Clearance
(mm)
(please contact relevant
asset owner for clearance
confirmation, e.g. Western
Power and Horizon Power)
Office Use Only:
Meets Guidelines:
Yes
No
Yes
No
Yes
No
Yes
No
Comments:
Please attach photos relevant to Overhead Clearances
Location
Road Features
(Description)
Photo
Insert Photograph Here (additional boxes should be added as required)
MAIN ROADS Western Australia
D16#72951 - RAV Route Assessment Form - August 2016
Page 11 of 22
Railway Crossings
11) Have any railway crossings been identified?
Yes
No
If Yes, complete Table 8 below.
If No, go to question 12.
Comments:
Table 8 - Railway Crossings
Please tick most appropriate
What is the main use for the railway?
What is the railway crossing protected by?
Freight
Passenger
Other
Give Way
Sign
Stop Sign
Flashing
Lights
Flashing
Lights with
Boom
Advance
warning
flashing
amber lights
No
Protection
Please answer the following
What is the angle between the railway line and the road?
Angle (degrees)
(Only applicable for crossings not protected by boom gates)
Sight Distances
(Only applicable for crossings not protected by boom gates)
Direction of Travel
Sight Distance LHS (m)
(e.g. South-West )
Sight Distance RHS (m)
Stacking Distances
If the railway crossing is near to an
intersection/T-junction, please specify stacking
distance measurements
Approach Stacking Distance (m)
or/and
Departure Stacking Distance (m)
MAIN ROADS Western Australia
D16#72951 - RAV Route Assessment Form - August 2016
Page 12 of 22
Office Use Only:
Does the railway crossing meet guideline requirements?
Yes
No
Comments:
Please attach photos relevant to the Railway Crossings
Location
Road Features
(Description)
Photo
Insert Photograph Here (additional boxes should be added as required)
MAIN ROADS Western Australia
D16#72951 - RAV Route Assessment Form - August 2016
Page 13 of 22
Intersections
Swept Path Analysis
12) Has a swept path analysis been conducted for each
intersection, corner & roundabout?
Yes
No
Please attach swept path assessments below.
Comments:
Office Use Only:
Do the swept paths meet guideline requirements?
Yes
No
Comments:
Please attach photos relevant to the Swept Paths
(Supply photos of intersections & swept path drawings)
Location
Road Features
(Description)
Photo
Insert Photograph Here (additional boxes should be added as required)
MAIN ROADS Western Australia
D16#72951 - RAV Route Assessment Form - August 2016
Page 14 of 22
Intersection Layout
13) Are intersection treatments satisfactory for RAV access?
i.e. sufficient stacking distance at centre islands
14) What types of kerbs are located at the intersection?
Mountable
Semi-Mountable
15) Particularly at rural sites, are all intersections free of loose
gravel?
Yes
No
Non-mountable
Yes
N/A
No
Comments:
Office Use Only:
Comments:
Please attach photos relevant to the Intersection Layout
Location
Road Features
(Description)
Photo
Insert Photograph Here (additional boxes should be added as required)
MAIN ROADS Western Australia
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Page 15 of 22
Intersection Sight Distance (entering SD – see Appendix F in the Standard Guidelines)
16) Is the sight distance acceptable for the Restricted Access
Vehicle category being assessed?
Yes
No
17) Is there anything restricting sight distance? (e.g.
trees, shrubs, parking bays/rest areas)
Yes
No
If Yes:
Can anything be done to increase sight distance
Yes
If Yes, please specify in the comment section below
No
Please complete Table 9.
Comments:
Table 9 – Intersection Sight Distance (entering SD – see Appendix F in the Standard Guidelines)
Name of
Intersecting
Road
(not the road being
assessed)
AADT
of
Intersec
ting
Road
Grade
of
Intersec
ting
Road
Posted
Speed
Limit of
Intersec
ting
road
Sight Distance
1 (m)
(specify direction
E.g. north east =
NE)
Direction:
Direction
Direction:
Direction:
Sight Distance 2
(m)
(specify direction)
Office Use
Only:
Photos
Attached
Meets
Guideline
Requirements
Direction:
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Direction:
Direction:
Direction:
Office Use Only:
Comments:
MAIN ROADS Western Australia
D16#72951 - RAV Route Assessment Form - August 2016
Page 16 of 22
Please attach photos relevant to Intersection Sight Distance
Location
Road Features
(Description)
Photo
Insert Photograph Here (additional boxes should be added as required)
MAIN ROADS Western Australia
D16#72951 - RAV Route Assessment Form - August 2016
Page 17 of 22
Stopping Sight Distance (approach SD – see Appendix E in the Standard Guidelines)
18) Is the stopping sight distance acceptable for the Restricted
Access Vehicle category being assessed?
Yes
No
19) Is there anything restricting the sight distance? (e.g.
trees, shrubs, parking bays/rest areas)
Yes
No
If Yes:
Can anything be done to increase sight distance
Yes
If Yes, please specify in the comment section below
No
Please complete Table 10.
Comments:
Table 10 – Intersection Stopping Sight Distance (approach SD – see Appendix E in the Standard
Guidelines)
Name of
Approaching
Intersection
(not the road
being assessed)
Posted
Speed Limit
Grade Approaching
the Intersection
(Please specify if it is a
downhill or uphill grade)
Stopping Sight
Distance (m)
Photos
Attached
Office Use
Only:
Meets Guideline
Requirements
%
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
%
%
%
Office Use Only:
Comments:
MAIN ROADS Western Australia
D16#72951 - RAV Route Assessment Form - August 2016
Page 18 of 22
Please attach photos relevant to Intersection Stopping Sight Distance
Location
Road Features
(Description)
Photo
Insert Photograph Here (additional boxes should be added as required)
MAIN ROADS Western Australia
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Page 19 of 22
Road Assets
Overtaking Opportunities
20) Is there suitable distance between two overtaking
opportunities?
Yes
No
N/A
Please specify the Maximum Average distance and Maximum distance between each overtaking
opportunity:
Maximum Distance
m
Average Distance
m
21) If no overtaking lanes have been identified, are there
suitable sight distances for overtaking?
Yes
No
Comments:
Office Use Only:
Do the overtaking opportunities meet guideline requirements?
Yes
No
Comments:
Off-Road Parking
22) Is this a rural road exceeding 80km in length
Yes
No
Yes
No
23) Does each parking facility meet stopping sight distance
requirements as per Appendix E in the Guidelines (page 27)?
Yes
No
24) Does each parking facility meet Table 11: Minimum
Clearance from Edge of Pavement for Parked RAV of the
guidelines (page 18)?
Yes
No
or
Is this a remote area road exceeding 120km in length?
If Yes to any of the above, answer question 21 and 22.
Comments:
Office Use Only:
Does the off-road parking meet guideline requirements?
Yes
No
Comments:
MAIN ROADS Western Australia
D16#72951 - RAV Route Assessment Form - August 2016
Page 20 of 22
Please attach photos relevant to Road Assets
Location
Road Features
Photo
(Description)
Insert Photograph Here (additional boxes should be added as required)
Community Considerations
25) What are the major concerns that need to be further address? (More than one may be selected)
Please specify any details in the remarks section below
Noise
Vibration
Smell
Other
Remarks:
26) What agencies have been contacted with regard to any community issues or concerns
Please specify any details in the nature of concerns section below
Regional Office
Local Shire
Local Police
Other
Nature of Concern:
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Please Complete
Assessment Officer Declaration:
I hereby declare that:
1. I have assessed this route in accordance with all requirements and procedures in Main Roads
Western Australia Guidelines for Assessing the Suitability of Routes for Restricted Access
Vehicles, and
2. The information provided on this form and the attached documents is true and correct to the best
of my knowledge.
Print Name:
Print Name:
Representing:
Representing:
Signed:
Signed:
Date:
/
/
Date:
/
/
Recommendation comments:
I hereby endorse the route’s suitability for RAV access as follows:
The route is unsuitable for RAV access.
The route is suitable for RAV access.
The route is suitable for RAV access under the standard conditions for a Low Volume road:
Type A Road
Type B Road
Under the following specific operating conditions:
This section must be signed by a CEO/ Deputy CEO or Regional Manager.
Print Name:
Signed:
Position Title
Date:
Attachment Checklist
Please use the following checklist to make sure you have attached all the appropriate documents for
this assessment. For photos or other attachments that require description or explanation, please
utilise the photo clipboard table below.
Original Application for the request of the route (if applicable)
Written approval from the road owner (this can be provided in an email)
Any relevant email correspondence (e.g. Western Power/Horizon Power)
Photos of important sections of the route (in the relevant sections throughout the form)
Swept path diagrams (if they have been completed)
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