Title Page
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Job / Document No.
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Site
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Conducted on
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Prepared by
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Additional Information If Required:
SERVICES
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What services are affected (e.g. women’s/men’s/disabled/staff WC; urinals; wash-hand basins; sinks)
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What is the suspected cause (e.g. blockage, scale, collapse, macerating pump, flush mechanism, cistern, foreign objects)
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What is the location of the fault (e.g. trap, internal pipe-work, external drain, stack)
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Draw the location of the fault
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Comments/general observations
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Insert general pictures where applicable:
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Are there any access issues or other problems if applicable (e.g. blind connection, panels, bellies, concealed manholes)
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Action taken (e.g. electromechanical device to clear scale in urinal; plunged toilet; rodded external manholes (if so, which ones?); rodded to/from stack; replaced urinal pipe-work; replaced macerating pump)
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Description of photos taken (e.g. electromechanical device to clear scale in urinal, plunged toilet, rodded external manholes, replaced urinal pipe-work, replaced macerating pump, replaced batteries)
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Is there any further action required? (e.g. other contractor, new parts, joint visit, CCTV, suspected collapse)
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Confirmation you have shown the site representative your work?
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Additional comments (e.g. number of previous call-outs; paper towels found in line; pulled back gravel; drain rod in line to report; foul pump station on site tested and found operational / non-operational)
GENERAL
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Do you have any comments or recommendations?
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Insert pictures:
OPERATIONAL
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Inspected all areas and confirm there are no NMPI situations?
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Confirm there are no other obvious defects that you could otherwise repair whilst on site?
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Confirm there are no other obvious defects that you could report to the help desk?
SIGNATURES
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Signature of Builder:
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Signature of the Site Manager (deputy):
