Title Page

  • Conducted on

  • Williamstown Sewer Lining Project


  • Client / Site:

  • Works Description:


  • Type of plug that is being installed / fitted

  • Diameter of pipe/ outlet to be isolated (cm)

  • Required holding pressure (Kpa)

  • Actual pressure (Kpa)

  • Photo evidence of the pressure gauge:

  • Is the plug & pipe connection maintaining the required pressures when tested<br>

  • Is the pressure controlling device in current calibration

  • Does the plug & connection show signs of any structural damages, breakages or loose fittings

  • Does the plug & pipe connection show signs of stress or distortion to integrity

  • If the plug is anchored or housed to another support connection point, are there any signs this connection is loose or poorly secured


  • Other Comments

  • Person Completing the Checklist

  • Signature:

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