Information

  • Work Order Number

  • Conducted on

  • Completed by

  • Location/Address
  • Work to be done description

Repair details

  • Urgency of repair

  • Work to be completed description

  • Enter Suggested Repair Time Identify preferred repair time based on site assessment and conditions Eg: Any time from Monday to Friday (9am - 3:30pm) Saturday or Sunday morning (5am - 9pm)

Environmental Issue/Impact

  • Are there any Environmental Issues/Impact or the potential to cause Environmental Impact?

  • What is the approximate flow rate of water?

Asset Location Details.

  • Are underground asset locations required?

  • DBYD - 1100 contacted for plans?

  • Telstra located with sub-site unit?

  • Is Telstra asset close to excavation?

  • SA Power Networks located with sub-site unit?

  • Is SA Power Networks asset close to excavation?

  • Does this require the asset owner to be on site?

  • Has a SAPN company representative been booked for attendance?

  • Gas located with sub-site unit?

  • Is Gas asset close to excavation?

  • Does this require the asset owner to be on site?

  • Has a Gas company representative been booked for attendance?

  • SA Water asset located with sub-site unit?

  • Is other Water/Wastewater asset close to excavation?

  • Are there any waste water contamination risks involved with the job?

  • Trans SA located with sub-site unit?

  • Trans SA asset close to excavation?

  • Public lighting located with sub-site unit?

  • Is public lighting asset close to excavation?

  • Are Fibre Optic cables close to excavation?

  • Have plans been attached/sent?

  • What details were given to operations centre to pass on?

  • Have other authorities been identified and contacted for plans?

  • Please name the asset authorities identified.

On Site HAZARDS

  • Are there any On SIte Hazards that have not been covered so far?

  • What Hazards have been Identified?

  • Has the operations centre been notified to pass on any hazards workers may come across at this job site?

Planning details

  • Shutoff required?

  • Has Active Field Map been completed?

  • Residential in shutoff block?

  • School in shutoff block?

  • Business in shutoff block?

  • Hospital in shutoff block?

  • Any other Critical Customers in the Shut Off Block?

  • What type of Critical Customer?

  • Number of valves in shutoff?

  • Notification cards required?

  • Number of cards required?

  • Traffic control required?

  • Can the work be performed by:

  • Work details for 2 X 1 manners

  • Please enter Details of Work Required.

Work and Fittings.

  • Fittings required for repair?

  • Welder required to perform on-site work?

  • Special requirements or instructions? Eg: shoring, hydro excavation, cold/hot mix, 2nd tipper, Dual axle Tipper

  • What is Required?

  • Add photo

  • Add Photo

  • Add Photo

  • Add Photo

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.