A4 Civils Site Audit Sheet

• Conducted on

  Date

• Prepared by

• Location
  Address

• Gang Name

• Gang ID

• Location

• 500 Number

• Active

  Yes

  No

  N/A

• Retro

  Yes

  No

  N/A

Job Description

• Pole bend

  Yes

  No

  N/A

• Blockage

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Excavation Size

• Width

• Length

Site General

• Does site comply with 'Safety at Streetworks' CoP

  Compliant

  Non-Compliant

  N/A

• Does Site have Information Board and Permit number

  Compliant

  Non-Compliant

  N/A

• Is appropriate uniform/PPE being Used Flame retardant/dust masks etc

  Compliant

  Non-Compliant

  N/A

• Site Tidy/Clear

  Compliant

  Non-Compliant

  N/A

Apparatus/Backfill/Sub-base

• Apparatus to correct depth

  Compliant

  Non-Compliant

  N/A

• Apparatus to correct configuration

  Compliant

  Non-Compliant

  N/A

• MOT Type 1 on site

  Yes

  No

  N/A

• Sand on site

  Yes

  No

  N/A

• SMR on site

  Yes

  No

  N/A

Material for backfill

• Type 1

  Yes

  No

  N/A

• Sand

  Yes

  No

  N/A

• SMR

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Correct compaction equipment used

  Compliant

  Non-Compliant

  N/A

• Correct depth left for asphalt

  Compliant

  Non-Compliant

  N/A

Blacktop

• Edges trimmed and sealed 2 applications

  Compliant

  Non-Compliant

  N/A

• Tack coat used carriageways

  Yes

  No

  N/A

• Base course complies with specification

  Compliant

  Non-Compliant

  N/A

• Correct compaction equipment used for base material (Trench wacker)

  Compliant

  Non-Compliant

  N/A

• Surface course complies with specification

  Compliant

  Non-Compliant

  N/A

• Correct compaction equipment used for surface course

  Compliant

  Non-Compliant

  N/A

• Lining replaced

  Compliant

  Non-Compliant

  N/A

• Any proximities evident

  Compliant

  Non-Compliant

  N/A

• Any depression/crowing

  Yes

  No

  N/A

• Other defects

Blocks/Slabs

• Sand bed used

  Yes

  No

  N/A

• Laid to correct bond

  Yes

  No

  N/A

• Correct mortar/sand used for joints

  Yes

  No

  N/A

• Units level, not rocking and not damaged

  Yes

  No

  N/A

Verge

• Made level and free from debris and stones (20mm and over)

  Yes

  No

  N/A

• Compacted and seeded/turf

  Yes

  No

  N/A

Notes/Comments

Remedials Required

Photographs

• Add media

  Media