Information
22773 EA - CULVERT INSPECTION & CLEANING CONTRACT
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Conducted on
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Project number
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Prepared by
Works detail
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Assessed priority
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Site Address
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Nature of Works
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Approx length
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Summary of findings
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Silt sample required?
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Number of men required for task
Inlet Structure
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Photo of Inlet structure
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Comments
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Photo of Watercourse upstream from inlet
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Comments
Culvert inlet
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Height (mm)
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Width (mm)
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Water depth (mm)
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Material
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If other please detail
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Approx silt depth at outlet (mm)
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Additional notes
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Overhead services
Access to Culvert
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Type of land
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If other please give details
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Restrictions & contact numbers
Working area
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Off road parking?
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Restrictions / directions
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Soft / uneven ground?
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Restrictions / directions
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Stock present?
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Restrictions / directions
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Traffic Management
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Restrictions / directions
Bridges
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Location
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Weight restriction
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Width restriction (mm)
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Height restriction. (mm)
Outlet structure
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Photo of outlet structure
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Comments
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Photo of watercourse downstream from outlet
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Comments
Culvert outlet
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Height (mm)
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Width (mm)
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Water depth (mm)
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Material
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If other please detail
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Approx silt depth at outlet (mm)
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Additional notes
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Overhead services
Access to culvert
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Type of land
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If other please give details
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Restrictions & contact numbers
Working area
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Off road parking?
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Restrictions / directions
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Soft / uneven ground?
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Restrictions / directions
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Live stock present?
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Restrictions / directions
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Traffic management
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Restrictions / directions
Bridges
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Location
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Weight restriction
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Width restriction (mm)
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Height restriction (mm)
Additional photographs
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Additional photo 1
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Note
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Additional photo 2
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Note
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Additional photo 3
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Note
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Additional photo 4
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Note
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Additional photo 5
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Note
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Additional photo 6
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Notes
Environmental & Pollution control
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Environmental or pollution Control Matters which might effect the risk Assessment .
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Any other matters relevant to the risk Assessment ?
Sign off
Report preparation
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Signature
