Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Water Authority Validation Officer present?

  • Tap to enter information
  • Personnel

Site overview

  • Inspection carried out the following time

  • Select date

  • Principal Contractor

  • Sewer Contractor

  • Number of workers on site

  • All actions from previous inspection report completed

General

  • Is confined space entry required

  • Tap to enter information
  • Has permit to work been obtained

  • Minimum number of staff on site? (3)

  • Correct equipment I.e. signage, harness

  • BWC auditor has witnessed live entry form

  • Has pre testing been complete?

  • Tap to enter information
  • Witness

  • Date witnessed

  • Tap to enter information
  • Why was it not witnessed

  • A copy of the pretest paperwork received?

Ovality testing

  • Ovality testing conducted?

  • Tap to enter information
  • 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

Vacuum Testing

  • Vacuum testing conducted?

  • Tap to enter information
  • Gauges

  • Gauge
  • Gauge Serial Number

  • Calibration date

  • Nominate MH numbers

  • Vacuum Testing Manholes & Lines

  • Manhole
  • Manholes & Lines

  • Time Started

  • kPa

  • Time Finished

  • Change in pressure

  • Result

Pressure Testing

  • Pressure testing conducted?

  • Tap to enter information
  • Gauges

  • Gauge
  • Gauge Serial Number

  • Gauge Calibration Date

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

  • Pressure Testing Lines

  • Line
  • Lines

  • Time Started

  • kPa

  • Time Finished

  • Change in pressure

  • Result

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.