150914 STW (East) R&M Inspection

• Document No.

• STW east R&M

General information

• SAP Order nr

• Maygurney order nr

• Grid ref X

• Grid ref Y

• Address

• Site location
  Address

• Postcode

• County

  Select Derbyshire Nottinghamshire Leicestershire Warwickshire Worcestershire Gloucestershire

  • Derbyshire
  • Nottinghamshire
  • Leicestershire
  • Warwickshire
  • Worcestershire
  • Gloucestershire

• Manhole inspection ?

  yes

  no

Manhole Inspection

• Manhole number ( if known)

• Start date / time

  Date

• Finish date / time

  Date

• Crew on site

  Select msn 1 msn 2 msn 3 msn 4 msn 5 msn 6 msn 7 msn 8 msn 9 msn 10 msn 11 msn 12

  • msn 1
  • msn 2
  • msn 3
  • msn 4
  • msn 5
  • msn 6
  • msn 7
  • msn 8
  • msn 9
  • msn 10
  • msn 11
  • msn 12

• HIGHWAY / PRIVATE / OTHER

  Select highway road private other highway verge

  • highway road
  • private
  • other
  • highway verge

• Manhole type

  Select Rising Main Foul Surface Combined N/A

  • Rising Main
  • Foul
  • Surface
  • Combined
  • N/A

• Surface type

  Select HRA SMA 10mm 6mm grass lawn block paving slabs concrete grass field stone hardcore soil PACO patch patterned concrete unmade

  • HRA
  • SMA
  • 10mm
  • 6mm
  • grass lawn
  • block paving
  • slabs
  • concrete
  • grass field
  • stone hardcore
  • soil
  • PACO patch
  • patterned concrete
  • unmade

• Description of works / comments

• Section 81?

  yes

  no

  do not know

• STW Asset?

  yes

  no

  do not know

• Transferred Asset?

  yes

  no

  do not know

• FOW required

  yes

  no

• Customer name

• Customer mobile nr

• Customer contact nr

• PTD Signed

  yes

  no

• Can we carry out works at any time<br>

  yes

  no

• Access details

• Reason for no PTD

  Select STW CONTACT REQUIRED NOT OWNER KIER SUPERVISOR REQUIRED PHONE CALL REQUIRED REFUSES ACCESS NO ONE IN AT PROPERTY

  • STW CONTACT REQUIRED
  • NOT OWNER
  • KIER SUPERVISOR REQUIRED
  • PHONE CALL REQUIRED
  • REFUSES ACCESS
  • NO ONE IN AT PROPERTY

• Access details

• Is job a P1 , 2 , 3 or 4

  yes

  no

• Have you contacted either MARK / STEVE or NIGEL

  Yes

  No

  no answer

• Scheduler called to raise job?<br>

  Yes

  No

  no answer

• Has the area been left safe

  yes

  no

• Protection in place ?

  Select signing and guarding re mat to seal surfacing boarded over chapter 8 signs left safe without any additional protection

  • signing and guarding
  • re mat to seal surfacing
  • boarded over
  • chapter 8 signs left
  • safe without any additional protection

• Why not safe ?

  Select insufficient barriers not STW cover / asset

  • insufficient barriers
  • not STW cover / asset

• FOW Priority

  Select P1. 2hrs P2 . 6hrs P3 . 24hrs P4 . 48 hrs P5 . 72 hrs P6 . 10 days P7 .14 days P8 . 21 days P9 . 30 days

  • P1. 2hrs
  • P2 . 6hrs
  • P3 . 24hrs
  • P4 . 48 hrs
  • P5 . 72 hrs
  • P6 . 10 days
  • P7 .14 days
  • P8 . 21 days
  • P9 . 30 days

• Replace or Reset?

  Replace

  Reset

• Cover type

  Select Heavy duty D600 highway Medium duty C250 vans Light duty B125 garden / drive

  • Heavy duty D600 highway
  • Medium duty C250 vans
  • Light duty B125 garden / drive

• Cover defect

  Select missing cover cracked / damaged cover polished surface rocking cover cover too low cover too high surfacing defective around cover

  • missing cover
  • cracked / damaged cover
  • polished surface
  • rocking cover
  • cover too low
  • cover too high
  • surfacing defective around cover

• FOW Traffic management

  Select chapter 8 give and take lane closure 2 way lights 3 way lights 4 way lights stop / go road closure none A / B Boards required on side road

  • chapter 8
  • give and take
  • lane closure
  • 2 way lights
  • 3 way lights
  • 4 way lights
  • stop / go
  • road closure
  • none
  • A / B Boards required on side road

• Approximate length of reinstatement required

• Approximate width of reinstatement required

• Manhole cover size

  Select 300 dia 450 dia 450 x 600 600 x 600 675 x 675 600 x 750 750 x 750 750 x 900 900 x 900 600 x 900 675 x 1220 a dimension greater than 1300mm

  • 300 dia
  • 450 dia
  • 450 x 600
  • 600 x 600
  • 675 x 675
  • 600 x 750
  • 750 x 750
  • 750 x 900
  • 900 x 900
  • 600 x 900
  • 675 x 1220
  • a dimension greater than 1300mm

• Are any manhole cover dimensions greater than 675 mm

  yes

  no

• Any manhole cover dimensions greater than 1300 mm

  yes

  no
Schedule 13 quote required Non standard cover order required

• Cover lifted

  yes

  no

• Manhole cover depth

  50

  100

  150

  200

• Reason why not lifted

  unable to lift

  traffic too great

• Customer Special Requirements?

  yes

  no

• Details

Specific Site detail Information

• Road markings

  yes

  no

• Markings detail

  white line

  yellow line (primrose)

  white and yellow

  red line

  yellow line (normal)

• Surface treatment ?

  yes

  no

• Surface treatment type

  Select anti skid buff anti skid grey anti skid green anti skid black anti skid red tar and chip specialist other material

  • anti skid buff
  • anti skid grey
  • anti skid green
  • anti skid black
  • anti skid red
  • tar and chip
  • specialist other material

• Road Width?

• Distance Kerb - Manhole?

• Bus Stop within 50m?

  yes

  no

• Traffic Control within 50m?

  yes

  no

• Traffic control alterations required ?<br>

  Traffic lights to bag / switch off ?

  Pedestrian crossing to bag / switch off ?

  Temporary bus stop required ?

• Any parked cars at time?

  yes

  no

• Could cars park ANY time?

  yes

  no

• Speed limit

  Select 30 mph 40 mph 50 mph 60 mph off road / not required

  • 30 mph
  • 40 mph
  • 50 mph
  • 60 mph
  • off road / not required

• Parking suspension

  yes

  no

• Any hand dig required?

  yes

  no

• Traced and Marked?

  yes

  no

Safety Information

• Overhead Power?

  yes

  no

• Lamp Support Required?

  yes

  no

• Confined Space Working?

  yes

  no

• Any Other Safety Information?

• Mitigation inspection?

  yes

  no

• Start date / time

  Date

• Is problem associated with STW asset

  yes

  no

• Customer name

• Customer mobile nr

• Customer contact nr

• Customer type

  domestic

  commercial

• Property type ?

  pre war terrace

  post war terrace

  semi detached

  detached

  bungalow

• Areas of property to be protected

  Select main building internal main building cellar attached garage detached garage outbuilding garden drive other

  • main building internal
  • main building cellar
  • attached garage
  • detached garage
  • outbuilding
  • garden
  • drive
  • other

• Details of flooding encountered

• Is protection possible ?

  yes

  no

• Mitigation requirements / possibilities

  Select non return valve in new chamber non return valve in existing chamber non return gulley sealed cover sealed and bolted down cover smart air bricks concrete slotted posts / gravel boards / timber panels re profiling drive pedestrian floodgate vehicular floodgate flood boards doorway flood boards garage soak away and surface water diversion new chamber c/w hatchbox brick / block / stone wall other

  • non return valve in new chamber
  • non return valve in existing chamber
  • non return gulley
  • sealed cover
  • sealed and bolted down cover
  • smart air bricks
  • concrete slotted posts / gravel boards / timber panels
  • re profiling drive
  • pedestrian floodgate
  • vehicular floodgate
  • flood boards doorway
  • flood boards garage
  • soak away and surface water diversion
  • new chamber c/w hatchbox
  • brick / block / stone wall
  • other

• Type of protection

  full protection

  reduce severity

  reduce frequency

• Design detail proposals

• Sketch of proposals

  Drawing

• Customer special requirements with respect to mitigation measures

• Is customer willing to agree to mitigation work

  yes

  no

• I / We agree to the afore mentioned works

  Sign

• PTD Signed

  yes

  no

• Can we carry out works at any time<br>

  yes

  no

• Access details

• Reason for no PTD

  Select STW CONTACT REQUIRED NOT OWNER KIER SUPERVISOR REQUIRED PHONE CALL REQUIRED REFUSES ACCESS NO ONE IN AT PROPERTY

  • STW CONTACT REQUIRED
  • NOT OWNER
  • KIER SUPERVISOR REQUIRED
  • PHONE CALL REQUIRED
  • REFUSES ACCESS
  • NO ONE IN AT PROPERTY

• Access details

• Customer Special Requirements with respect to access

  yes

  no

• Details

• Explanation of reasons

• Source of problem

  Select highway drainage issue run off from private land other

  • highway drainage issue
  • run off from private land
  • other

• Notes:

• Description of works / comments

• Draw sketch here if required.

  Drawing

• Location photos

  Media