Title Page

  • Work Order No.

  • Contractor Name

  • Conducted on

  • Inspection Done by

  • Location
  • Personnel on site

Health & Safety

  • Are all personnel wearing correct PPE? (long sleeves, long pants, safety glasses, hard hat if req'd, hearing protection if req'd)

  • Is the PPE in good condition and in date - where applicable?

  • Has an external Traffic Management Company been engaged and set up correctly?

  • Has Traffic Management been set up by correctly by the contractor?

  • Is the work site free of tripping hazards? eg tools lying around, excavation debris, uneven ground, kerbing

  • Do all employees on site have their Allwater/Skytrust card and have they completed an Allwater induction? Scan all available QR Codes.

  • Are any employees working in a confined space?

Environmental Protection

  • Are all Environmental risks controlled? eg mud entering storm water, waste water overflows contained

  • Has a clean up been conducted (if required) to minimise any Environmental Impact?


  • Has the contractor completed a JHA before starting work?

  • Have they identified any Risks/Hazards?

  • Do all identified Risks/Hazards have controls in place?

  • Has every person on site, including yourself, signed on to the JHA?

  • Is today a Fire Ban day? If yes, enter permit No. for any hot works.

  • Have all underground services been located and marked?

  • If working on Cast Iron or Asbestos pipe, are contractors applying all safety procedures?

  • Is a main isolation required? If yes, who de-pressurised the main?

Plant & Equipment

  • Are all hand tools in good working condition?

  • Are all electrical tools tested, tagged and in date?

  • Do all vehicles in the work zone have flashing or rotating beacons?

  • Are flashing or rotating Beacons operational?

Organisation and Efficiency

  • What type of work is being done? eg Burst main, Sewer Connection Fault

  • Are all employees on site actively engaged in the task?

  • Is the excavation greater than 1.5 metres deep? What measures have been taken to mitigate any risk of collapse? Eg benching, shoring, battering etc.

  • What size bucket is being used on the excavator/backhoe?

  • Is the bucket size on the excavator/backhoe appropriate for the task?

  • Have all necessary parts for the repair been brought to site?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.