Information

  • Site Name:

  • Site ID:

  • Location
  • Prepared by

  • Conducted on

Construction

  • Start Date:

  • End Date:

  • In-house Crew or Contractor? Please specify.

Scope of Work

Media (Pre/During/Post)

  • Facility Pictures

  • Trench/Bore

  • Construction Pictures Before

  • Construction Pictures During

  • Construction Pictures After

  • Tap in installation

  • Construction Pictures Before

  • Construction Pictures During

  • Construction Pictures After

  • Pictures of Dig Ticket

  • Reference #

  • Pictures of Located Utilities

  • Special Remarks

  • Additional Instructions or Pictures

As-builts

  • Pictures of marked up plans

Inventory

  • Riser

  • Conduit Footage

  • Flow stop

  • Tracer Wire

  • Fusion coupling

  • Crimp on coupling

  • No blow saddle

  • Misc. Pictures

Sign-off

  • Auditor's signature

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.