INCIDENT PROFORMA

LANDSLIDE/SLOPE FAILURE DATABANK

FILL IN BOXES OR MARK APPROPRIATE ANSWER

State & District Route number: (road only) Slope ID: (filled in by CKC) Occurrence number:
(filled in by CKC)

STEP 1 INSPECTION DETAILS 1.1 INSPECTED BY:

1.2 DATE & TIME: DATE: TIME: AM / PM

1.3 WEATHER: SUNSHINE CLOUDY LIGHT RAIN HEAVY RAIN

STEP 2 GENERAL INFORMATION 2.1 LOCATION NAME:

2.2 SECTION NO: 2.4 FEATURE TYPE: EMBANKMENT CUT

(Road only)

NATURAL SLOPE OTHERS

2.3 DISTANCE: (from KM post)
(Road only)

2.5 COORDINATE: 2.6 ELEVATION : 2.7 FEATURE ASPECT:

NORTHING :
(WGS 84)
m
EASTING :

2.9 AGE:
2.8 ROAD SIDE: (If known)
LEFT RIGHT

2.11 ESTIMATED TIME TIME: AM / PM

2.10 DATE FAILURE FAILURE OCCURRED:
OCCURRED:

STEP 3 STATUS OF FEATURE

3.1 SEVERITY CODE:

CUTS and NATURAL SLOPES
1 Minor shallow failure (<5m in length) 1
Localised surficial loosening, localised evidence of fallen
2 2
material (rock) at base of slope
General evidence of fallen blocks and/or boulders at base
3 3
of slope
Failure affecting more than one berm but not the whole
4 4
slope
5 Failure extending height of slope 5
EMBANKMENTS
Cracks on embankment crest, road unaffected, no
subsidence, no other evidence of failure
Shallow failure on embankment surface, no crack or
depression on road
Arcuate cracks on road and/or depression less than
10cm - otherwise no mass movement evident
Slope failure with arcuate cracks on road and/or
depression less than 10cm
Slope failure with extensive arcuate cracks on road
and/or depression greater than 10cm

*arcuate means 'in the shape of an arc' 6 Failure of slope and road - diversion required

3.2 NUMBER OF FAILURES PRESENT WITHIN A SLOPE: This is failure no.:

Lf AREA
3.3 FAILURE TYPE: 3.4 w d
AFFECTED
Toppling/Wedge/Planar/Rockfall Width(m) Depth(m) Length(m) (%)
Rotational/Translational/Slump FAILURE DETAILS:
Circular/Mud flow/Debris flow
Creep/Subsidence

3.5 LOCATION OF FAILURE: Top Middle Base Whole Slope

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 3.6 (a) SOIL TYPE: 3.7 MAJOR STRUCTURAL
GEOLOGY:
(b) ROCK TYPE: (filled by geologist)
(filled by geologist)

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3.8 SLOPE GEOMETRY:
(a) SLOPE LENGTH, (b) BASE LENGTH (c) SLOPE HEIGHT (d) SLOPE ANGLE
Ls,(meters) BL, (meters) H, (meters) ()

3.9 RUNOUT DISTANCE: m 3.10 ANGLE OF FAILURE

MATERIAL:

3.11 TENSION CRACK: Presence of tension

W, maximum width (m) L, maximum length (m) Water filled ?
crack?

PRIMARY FAILURE NO YES NO YES

3.12 PRIMARY CAUSE?: APPARENT CAUSE OF FAILURE (APPLY YOUR ENGINEERING JUDGMENT)
Overly Poor/Weak High Geological
Rainwater Erosion Other
steep material groundwater factor
Describe

3.13 FAILURE MATERIAL: Soil with Soil with

Soil Rock Minor (50m3)
(Mark one only) cobbles boulders
Moderate (>50m3, 500m3)
3.14 Major ( > 500m3)
Volume

STEP 4 FAILURE IMPACT

4.1 ROAD CONDITION: 1 Passable (only minor clearing work required)

2 Passable but required immediate remedial work
3 Passable following minor clearing/remedial work
4 Passable only after clearing/remedial work
5 Closed until completion of major clearing/remedial work

4.2 ESTIMATED ROAD CLOSURE TIME: 0 Day 1-2 Days 3 Days

4.3 SERVICE TYPE: CABLE PIPELINE

Other
(describe)
(a) VICINITY OF High Low
NO YES ---> Telephone Fibre optic Water Sewerage Gas
SLOPE CREST voltage voltage
(b) VICINITY OF High Low
NO YES ---> Telephone Fibre optic Water Sewerage Gas
SLOPE TOE voltage voltage

4.4 FACILITY TYPE AFFECTED BY FAILURE: 4.5 INJURY/FATALITY/DAMAGES:

(a) No. of people
GROUP DESCRIPTION injured
Presence of any residential building, commercial office, store, (b)
No. of fatality
shop, hotel, factory, school, power station, ambulance station,
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market, hospital, clinic, welfare centre, bus shelter, dangerous (c) Other damages & 1. Building ( )
goods storage area number 2. Bridge ( )
Road, built up area (e.g. indoor carpark, building, mosque, 3. Vehicle ( )
2 church, temple, manned substation, sewerage treatment plant, 4. Livestock ( )
railway, flyover, subway, reservoir, construction site) 5. Other (Describe)

Densely used open space and public waiting area (e.g.

3
playground, open carpark, picnic area)
Lightly used open-air recreation area, non-dangerous goods (d) Estimated
4
storage area, intensive agricultural area, golf course economic loss
No facilities present or remote area (e.g. jungle, plantation, (RM)
5
forest, low intensity agriculture)
4.6 ENGINEERING JUDGMENT (IN YOUR OPINION):
(a) The consequence of a failure at this location was Low Moderate High
(b) Probability of additional movement Low Moderate High
(c) Probability of significant impact to the roadway, structures,
Low Moderate High
adjacent properties or features
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(c) Probability of significant impact to the roadway, structures,
Low Moderate High
adjacent properties or features

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STEP 5 SITE SKETCH

5.1 SITE SKETCH: (Use additional paper if required)

5.2 PHOTOGRAPH: (Please include picture reference) FAILURE 1

(e.g. Areas of heavy seepage, surface flow, saturated ground, etc)

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STEP 5 SITE SKETCH
5.3 GEOLOGY/TOPOGRAPHY/DRAINAGE SKETCH: (By geologist)
(e.g. Rock boundry, geological feature, stream, spring and others)

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STEP 6 6.1 EYE WITNESS ACCOUNT:
(e.g. Weather when failure occurred, antecedent weather, speed of failure, and other details)

6.2 GENERAL COMMENTS: (If Any. Use additional paper if required)

STEP 7 QUALITY ASSURANCE

7.1 CHECK LIST: YES DATE NAME INITIALS

TO BE COMPLETED
COMPLETION CHECK UNDERTAKEN? IN THE FIELD

TO BE COMPLETED
TRANSFER TO SOFTCOPY IN FIELD OFFICE

END