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      YELLOW TIME CONFIRMATION FORM Version V2.4.1  
 
  Contact:  Robert Priest  
  Position:  Vic Roads / DJR Liaison Officer  
  Phone:  9881 8721  
  Email:  Robert.Priest@roads.vic.gov.au  
  BA file No.:  CS / 910 / DOJ / 016  
  VR Re. No.:    (Allocated by Liaison Officer)  
  ………………..  
 
  To:    Manager, Camera Compliance, Research & Development  
  Infringement Management & Enforcement Services (IMES)  
  Department of Justice and Regulation (DJR)  
 
  From:  Department of Justice and Regulation Liaison Officer  
  VicRoads (VR)  
 
  Traffic Signal Details  
     
  1.  Location and Site Details:  
 
    Intersection:     
 
    VicRoads Site No.:    
 
    DJR Road Safety Camera Site No ('s)         
  ( Can be obtained from Safety Camera Site List, Quick Docs Ref No. 3490759)  
 
  Purpose of Check  
     
  2.  Signal Operation Check Instigated because of:  
 
        Speed change from ……..……..  to  ……..………  on  …………….……..  approach  
         ……..……..  to  ……..………  on  …………….……..  approach  
 
      Traffic Signal Controller replacement  
 
      Intersection Remodel (hardware and phasing changes including LED upgrade)  
 
      New Road Safety Camera Installation  
 
      DJR request check of specific site  
     
     Other (Please Specify)                
 
  Yellow Time Confirmation Check  
     
  3.  Confirmation Check  
  This site has been checked for 'Yellow Time' compliance in accordance with current guideline for  
  all approaches to the Intersection state above.  
     
  Safety Camera approach speed confirmation.  
  Located on Road        approach      speed    
 
  Checked By:           Date:  ….... / …….  /  ………………  
  VicRoads   (Manager Signal Services. Print name and signature required)  
 
  DJR Received:           Date:  ….... / …….  /  ………………  
  Document (Print name and signiture required. Email back to VicRoads Liaison Officer)  
 
  DJR Reference No.:   DJR Comments attached    Yes  /  No        (For DJR offical use only)
 
  Document No.: 1724846 Yellow Time Confirmation Form