Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Last Inspection conducted

  • Prepared by

  • Location
  • Inspection party

  • Add member
  • Name

  • Position

  • Company

Operational Status at time of inspection

  • Dam Details

    Dam details.png
  • Consequence Category

  • Storage Level Gauge board (m), FSL=23.00

  • Storage Level mAHD, FSL = 117.25

  • Water in Storage ML, capacity at FSL = 6,140ML

  • release via spillway

  • Other Comments

  • Photos

  • Sketch

Conditions at time of inspection

  • Weather

  • Estimated Max Temperature degrees celsius

  • Sky

  • Wind

  • Rain

  • Days since last rain

  • Other Comments

  • Photos

  • Sketch

Dam Safety Management

  • O&M Manual on Site

  • O&M Manual Reviewed

  • Dam Safety Emergency Plan on Site

  • Dam Safety Emergency Plan reviewed

  • Drawings on site

  • Operator Knowledge

  • Operator training

  • Other Comments

  • Photos

  • Sketches

Crest

  • Cracks

  • Vegetation

  • Sink Holes

  • Subsidence

  • Overtopping

  • Wheel ruts

  • Other deficiencies/comments for the crest.

  • Take photos of any deficiencies found on crest

  • Sketch

Downstream Face

  • Cracks

  • Slips

  • Erosion

  • Vegetation

  • Animal Activity

  • Bulges

  • Subsidence

  • Seepage

  • Wave effects

  • Rock facing

  • Other deficiencies/comments for the downstream face

  • Photos

  • Sketch

Upstream Face

  • Cracks

  • Slips

  • Erosion

  • Vegetation

  • Subsidence

  • Animal Activity

  • Bulges

  • Wave Effects

  • Rock Facing

  • Take photos of any deficiencies found on upstream face

  • Other deficiencies/comments for the upstream face

Abutments

  • Cracks

  • Slips

  • Erosion

  • Vegetation

  • Subsidence

  • Seepage

  • Take any photos of abutment observations

  • Other deficiencies/comments for abutments

Area Downstream of Dam

  • Subsidence

  • Bulges

  • Seepage

  • Seepage trenches

  • Weir Waterhole

  • Segnit's waterhole

  • Comments

  • Photos

  • Sketch

Spillway

  • Upstream approach

  • Ogee crest

  • Flow splitter walls

  • Channel floor

  • Channel walls

  • Stilling basin weir

  • Downstream erosion protection

  • Road bridge

  • Vegetation

  • Seepage

  • Other comments

  • Plan of spillway

  • Photos

  • Sketch

Outlet works

  • Valve house

  • Pipework

  • Security

Valves

Top Valve

  • Valve

  • Screen

  • Operating Mechanism

Middle Valve

  • Valve

  • Screen

  • Operating mechanism

Bottom Valve

  • Valve

  • Screen

  • Operating mechanism

  • Other comments

  • Photos

  • Sketch

Outlet Works Operation

  • Valve Schematic

    Vlaves.png
  • Top valve BT1 status

  • Top Valve BT1 tested

  • Top Valve BT1 last tested

  • Top Valve BT1 test satisfactory

  • Other comments

  • Photos

  • Middle valve BT2 status

  • Middle valve BT2 tested

  • Middle valve BT2 last tested

  • Middle valve BT2 test satisfactory

  • Other comments

  • Photos

  • Bottom valve BT3 status

  • Bottom valve BT3 tested

  • Bottom valve BT3 last tested

  • Bottom valve BT3 test satisfactory

  • Other comments

  • Photos

  • Outlet guard valve (BT4) status

  • Outlet guard valve (BT4) tested

  • Outlet guard valve (BT4) last tested

  • Outlet guard valve (BT4) test satisfactory

  • Other comments

  • Photos

  • Bypass valve (BT5) status

  • Bypass valve (BT5) tested

  • Bypass valve (BT5) last tested

  • Bypass valve (BT5) test satisfactory

  • Comments

  • Photos

  • Scour valve (BT9) status

  • Scour valve (BT9) tested

  • Scour valve (BT9) last tested

  • Scour valve (BT9) test satisfactory

  • Comments

  • Photos

  • Isolating valve (BT7) status

  • Isolating valve (BT7) tested

  • Isolating valve (BT7) last tested

  • Isolating valve (BT7) test satisfactory

  • Comments

  • Photos

  • Isolating valve bypass (BT8) status

  • Isolating valve bypass (BT8) tested

  • Isolating valve bypass (BT8) test satisfactory

  • Isolating valve bypass (BT8) last tested

  • Comments

  • Photos

Outlet tunnel

  • Concrete lining

  • Pipework

  • Valves

  • Tunnel plug

  • Lighting

  • Walkway

  • Downstream channel

  • Security

  • Drainage

  • Ventilation

  • Other comments

  • Photos

  • Sketch

Access to Dam

  • Right Abutment

  • Left abutment

  • Other access to dam notes

  • Sketch

  • Access to dam photos

Reservoir

  • Landslips around rim

  • Boat Ramp

  • Other comments

  • Sketch

  • Photos

Communications

  • Telemetry

  • Telephones

  • Radios

  • Other comments

  • Sketch

  • Photos

Power Supply

  • Normal

  • Standby

  • Other comments

  • Sketch

  • Photos

Instrumentation

  • Pnuematic piezometers

  • Vibrating Wire piezos

  • Standpipes

  • Survey targets

  • Seepage weirs

  • Other comments

  • Photos

  • Sketch

Surveillance

  • Consequence Category

  • Rainfall

  • Rainfall observation frequency meets ANCOLD guidelines

  • Storage Level

  • Storage Level Observation frequency meets ANCOLD guidelines

  • Seepage

  • Seepage Observation frequency meets ANCOLD guidelines

  • Seepage Analysis

  • Seepage Analysis observation frequency meets ANCOLD guidelines

  • Pore Water Pressure

  • Pore water pressure observation frequency meets ANCOLD guidelines

  • Surface Displacement

  • Surface Displacement observation frequency meets ANCOLD guidelines

  • Internal displacement

  • Internal displacement observation frequency meets ANCOLD guidelines

  • Seismological

  • Seismological observation frequency meets ANCOLD guidelines

  • Telemetry

  • Telemetry observation frequency meets ANCOLD guidelines

  • Visual Inspections

  • Visual Inspection observation frequency meets ANCOLD guidelines

  • Other comments

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.