Title Page

  • Site Conducted

  • Conducted by

  • Date

Shed

  • Location of shed
  • Height of bottom of shed

  • Photo of shed

  • Photo of inside shed and instrument box

  • Is maintenance or upgrade required?

  • describe maintenance required

  • describe upgrade required

Benchmark

  • Location of BM
  • Picture of BM

  • Is maintenance or upgrade required?

  • describe maintenance required

  • describe upgrade required

Pit

  • Location of pit
  • Height of pit

  • Photo of pit

  • Type and serial number of sensors

  • Photo of sensors

  • Is maintenance or upgrade required?

  • describe maintenance required

  • describe upgrade required

Gauge range and orifice lines

  • Photo of gauge range

  • Has annual survey been completed?

  • Is maintenance or upgrade required?

  • describe maintenance required

  • describe upgrade required

Control

  • Location of control
  • Photos of control

  • Is maintenance or upgrade required?

  • describe maintenance required

  • describe upgrade required

Site general

  • Vegetation

  • Hazards

  • Comments

  • Photos of other

  • Landholder details

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.