Title Page

  • Feature ID

  • How many blockages on this section (if more than 1, record extras ID's below)

  • What are the associated feature ID's (any additional blockages)

  • Exchange

  • Date

  • Gang Lead

  • Location

Health & Safety

  • Have you completed a Risk Assessment (Ensure Safe Digs are in date & Cover Excavation Area) Upload pic of completed form.

  • Why haven't you completed a RA. STOP work! EVERY job requires you to complete a suitable risk assessment

  • Speed of road

  • Do you have access on site to the "Safety at Street Works and Road Works. A Code of Practice"? (Red Book)

  • Is this a HOT JOB? (Is there medium or high pressure pipeline in the vicinity)

  • Has authorisation been given to dig from management? If the answer is "No", Stop work immediately and contact your supervisor.

  • Confirm the name of person authorising excavation?

  • STOP WORK AND CONTACT YOUR SUPERVISOR

  • Provide Photo evidence of calibrated CAT & GENNY (with cable clamp) and GDU available on site

Pre-Site

  • Provide a minimum of 4 Pre-Start photos, at least one from all directions of excavation area (Take photos of immediate surroundings to show existing conditions and to protect yourself from any potential damage claims)

  • Provide photos of existing services clearly marked up. You MUST include a perspective view photo of at least 5m radius otherwise it will fail validation (DO NOT JUST TAKE A CLOSE UP PIC)

  • Provide Site Set-up photos at least one from each direction clearly showing the CORRECT Chapter 8 in place. Ensure your site is secure and fully barriered off to prevent public access.

Damage Evidence

  • Provide multiple photos of the exposed duct before you carryout any repairs. You MUST include a perspective view photo of at least 5m radius otherwise it will fail validation (DO NOT JUST TAKE A CLOSE UP PIC)

Duct Repair Evidence

  • Provide clear photos of where repair meets existing duct / Structure before covering cables with split duct. To pass validation a repair kit must be used and clearly visible on all joints to existing duct. Except when repairing 2" duct. Repairs of 2" duct must be on the outside of the existing duct either using the wider socket end or using a collar. (Do not split the duct and insert it into the existing)

  • Provide photos of repairs including both collars and cable ties. All spilt duct & Spilt collars must be securely cable tied at 150mm apart (Pole bend blockages must include photos of the existing cable within the new repair and Elephants Foot)

  • Provide photos of completed the repair BEFORE backfill. You MUST include a perspective view photo of at least 5m radius otherwise it will fail validation (DO NOT JUST TAKE A CLOSE UP PIC)

  • Provide photos of job and chambers roped each end.

Reinstatement Status

  • Have you back filled the excavation?

  • Why Not?

  • Provide photos showing removal of spoil (excavated material) and the new backfill material used before and after compaction. If in FW or CW you must use clean Type1 aggregates to backfill.

  • Have you reinstated the surface in tar? (Base course and Surface course Required)

  • Reinstatement MUST comply to HAUC Specification not just matching existing surface. Carefully select the correct method from this document. Refer to full specification in the HAUC if necessary

  • Reinstatement Type Completed? (use above document to confirm specification)

  • Provide Reinstatement photos showing depth measure of base course. You MUST include a perspective view photo of at least 5m radius otherwise it will fail validation (DO NOT JUST TAKE A CLOSE UP PIC)

  • Provide Reinstatement photos showing depth measure of surface course. You MUST include a perspective view photo of at least 5m radius otherwise it will fail validation (DO NOT JUST TAKE A CLOSE UP PIC)

  • Have you reinstated the surface in verge / unsurfaced material

  • Provide photos of fully reinstated surface (All verges must be top soiled and seeded). You MUST include a perspective view photo of at least 5m radius otherwise it will fail validation (DO NOT JUST TAKE A CLOSE UP PIC)

  • Are there any further reinstatement requirements (e.g Concrete, Slabs, Block Paving, Coloured Surfaces, other)

Job Completion

  • Surface Type

  • Provide Dig dimensions: length x Width & Breakdown measures by surface/Type (e.g FW = 3.4m x 0.4m, CW = 8.2m x 0.3m) or (Chamber = 1.9m x 1.3m - F/w, Duct = 1.7m x 0.4m - F/w). Be accurate to avoid an FPN from the Council for recording wrong details.

  • Does Excavation exceed 3m?

  • Record Grid Reference at Start Point
  • Record Grid Reference at End Point
  • Exact Address of Dig (Please be as accurate as possible e.g O/s 13 Clover Way or Opp 2 Fir Tree Ave)

  • Comments / Outcome

  • Why Not?

Confirmation

  • Is Job Complete, Reinstated & Site Clear

  • Provide Site Clear or Left Safe Ready For Reinstatement Photos

  • A55 Completed (ensure A55 is fully completed and accurate measures between chambers and blockages)

  • Why is an A55 not required (an A55 is necessary for all excavations)

  • Gang Lead 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.