Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Water Authority Validation Officer present?
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Personnel
Site overview
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Inspection carried out the following time
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Select date
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Principal Contractor
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Sewer Contractor
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All actions from previous inspection report completed
General
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Is confined space entry required
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Has permit to work been obtained
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Minimum number of staff on site? (3)
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Correct equipment I.e. signage, harness
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BWC auditor has witnessed live entry form
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Has pre testing been complete?
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Witness
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Date witnessed
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Why was it not witnessed
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A copy of the pretest paperwork received?
Ovality testing
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Ovality testing conducted?
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Deflection Tolerance (table 22.7)
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Prover Outside Diameter (table G1)
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Ball serial number
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Circumference Tape Measure
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Nominate lines tested by u/s & d/s MHs
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Lines Tested
Line
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Lines tested
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Result
Vacuum Testing
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Vacuum testing conducted?
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Gauges
Gauge
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Gauge Serial Number
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Calibration date
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Nominate MH numbers
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Vacuum Testing Manholes & Lines
Manhole
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Manholes & Lines
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Time Started
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kPa
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Time Finished
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Change in pressure
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Result
Pressure Testing
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Pressure testing conducted?
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Gauges
Gauge
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Gauge Serial Number
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Gauge Calibration Date
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Nominate lines tested by u / s & d / s MHs
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Pressure Testing Lines
Line
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Lines
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Time Started
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kPa
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Time Finished
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Change in pressure
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Result
Summary
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Safety Advisors Comments
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Photo Records:
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Safety Advisor
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Site Representative
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I confirm that all actions highlighted within this report have been completed
