B.W. Sewer Testing Inspection Report

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Water Authority Validation Officer present?

  Yes

  No
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• Name

Site overview

• Inspection carried out the following time

• Select date

  Date

• Principal Contractor

• Sewer Contractor

• Number of workers on site

• All actions from previous inspection report completed

  Yes

  No

  N/A

General

• Is confined space entry required

  Yes

  No
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• Has permit to work been obtained

  Yes

  No

  N/A

• Minimum number of staff on site? (3)

  Yes

  No

  N/A

• Correct equipment I.e. signage, harness

  Yes

  No

  N/A

• BWC auditor has witnessed live entry form

  Yes

  No

  N/A

• Has pre testing been witnessed?

  Yes

  No

  N/A

• Witness

• Date witnessed

  Date

• A copy of the pretest paperwork received?

  Yes

  No

  N/A

Ovality testing

• Deflection Tolerance (table 22.7)

• Prover Outside Diameter (table G1)

• Ball serial number

• Circumference Tape Measure

• Nominate lines tested by u/s & d/s MHs

• Lines Tested

Line

• Lines tested

• Result

  Pass

  Fail

Pressure Testing

• Gauges

Gauge

• Gauge Serial Number

• Gauge Calibration Date

  Date

• Nominate lines tested by u / s & d / s MHs

• Pressure Testing Lines

Line

• Lines

• Time

  Date

• KPa

• Change

• Result

  Pass

  Fail

Vacuum Testing

• Gauges

Gauge

• Gauge Serial Number

• Calibration date

  Date

• Nominate MH numbers

• Vacuum Testing Manholes & Lines

Manhole

• Manholes & Lines

• Time

  Date

• KPa

• Change

• Result

  Pass

  Fail

Summary

• Safety Advisors Comments

• Photo Records:

  Media

• Safety Advisor

  Sign

• Site Representative

  Sign

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