Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Water Authority Validation Officer

Site overview

  • Inspection carried out the following time

  • Select date

  • Site overview

  • Principal Contractor

  • Sewer Contractor

  • Number of workers on site

  • Weather

  • Site conditions

  • Additional site conditions:

  • All actions from previous inspection report completed

Trench/Surface Restoration

  • Have private properties given acceptance

  • Sewer has adequate protection from heavy machinery

  • All disturbed surfaces have been reinstated

Maintenance Holes

  • Chases are free of ponding

  • Channels are smooth & well formed - No corners/correct radius

  • Pipes do not protrude into chase

  • Is dummy chase required/provided

  • Drops meet specification & have minimum of 1 bracket & 60° bend at bottom

  • M/H's over 6m have ladders and landings

  • Ladders have holdfasts spaced 1500 maximum

  • Top Step of Ladder is maximum 600 from surface

  • Bottom step of Ladder is maximum 325 minimum 200 from base

  • Step irons are maximum 600 from surface

  • Step irons are minimum 400 from surface

Drop Structures

  • Drops are vertical

  • Drops have correct table design (directed to outlet without bends)

  • Drops have concrete filled behind structure and is smooth and draining into chase

  • Drops are positioned correctly and structurally sound

  • Drops greater than 1200 have a second bracket

Sewer Lines

  • Correct pipe class/in date

  • Bedding Material is approved

  • Bedding depth is adequate

  • Backfill material meets requirements

  • Jointing meets requirements

  • Sewer main has adequate clearances from other services

  • Is trench excavation adequate and clean (no rocks, clean edges)

  • No cut in's on curved lines

  • Lines are free of infiltration & other visable faults

  • Isolation plugs & platforms have all been removed

Sewer Management

  • Contractor has Project Management Plan onsite and up to date

  • Contractor has Safe Work Method Statement (SWMS) on site and up to date

  • Contractor has Inspection Test Plan on site and up to date

  • Contractor has Tool Box meeting minutes on site and up to date

  • Contractor has Site Induction requirements and documentation on site and up to date

  • Contractor has Approved up to date construction plan on site

  • Contractor has One call documentation on site and up to date

  • Nominated supervisor on site

O.H.S Checks

  • Red card

  • Traffic

  • Correct PPE Hats, Vests

  • Isolation of live sewer

  • Barricading

  • First aid

  • Power

  • Water

  • Toilets

  • General safety

Traffic control

  • Is traffic control required

  • Workmen ahead signage

  • Detour ahead signage

  • Arrow boards

  • Road closed signage

  • Is traffic management plan in place

  • Are bollards being used in a reasonable manner

  • Is pedestrian access in place

Excavations / Trenching

  • Are there any excavation works

  • Is trenching / excavation > 1.5m deep

  • Edge protection & ladder access in place

  • Are shields being used

  • Is benching being used

  • Are road plates required and available

  • Are road plates in use

  • Is there a "Mine Mangers" certificate holder on site

  • Is spoil away from edge of trench

  • Is there access into and out of the trench

  • Are the trenches backfilled if no more work is required

  • Is barricading suitable

  • Has allowance for underground services and protection been made

Confined Spaces

  • Is confined space entry required

  • Has permit to work been obtained

  • Is entry to a confined space required

  • Is signage in place

  • Do personal have confined space entry ticket

  • Is breathing apparatus in use

  • Pits > 1.5 required for assessment

Materials

  • Delivery / Handling / Storage

Temporary bench marks

  • Marked and maintained

Machinery

  • Is machinery in use

  • Does plant have flashing lights that are working and being used

  • Does plant have reversing beepers

  • Does plant have roll over cages / protection where required

  • Has provision for O/H services been allowed for

Environment

  • Runoff controlled (silt fence, hay bales ect)

  • Dust controlled

  • Noise acceptable

  • Tree protection zones in place

Summary

  • Safety Advisors Comments

  • Photo Records:

  • Safety Advisor

  • Site Representative

  • I confirm that all actions highlighted within this report have been completed

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.