Works detail

Grid reference / Postcode

GPS location
Type of works

If other, please state.

Access to a Confined Space

Silt sample taken?

If no, please state why (e.g. no cleaning is required, Water level too high etc.)

Number of men required for task

Primary Route of Access

Inlet Structure

Culvert inlet

Inlet found?

Photo of Inlet structure

Comments

Photo of Watercourse upstream from inlet

Comments

Photograph of culvert internal

Comments

Height (mm)

Width (mm)

Water depth (mm)

Nearby Structures

If other, please state

Material

Shape

Type

Assumed silt level?

Photo of Inlet Area

Why not found? (Overgrown, Denied Access, etc.)

Vegetation clearance required?

Access to Inlet

Type of Access

Please state possible restrictions (e.g. Key)

Please state the weight limit

Land Owner Details :

Land Access Payment Required

Value of Payment (£)

Additional notes

Overhead services

Outlet Structure

Culvert outlet

Outlet found?

Photo of Outlet structure

Comments

Photo of Watercourse downstream from outlet

Comments

Photograph of culvert internal

Comments

Height (mm)

Width (mm)

Water depth (mm)

Nearby Structures

If other, please state

Material

Shape

Type

Assumed silt level?

Photo of Outlet Area

Why not found? (Overgrown, Denied Access, etc.)

Vegetation clearance required?

Access to Outlet

Type of Access

Please state possible restrictions (e.g. Key)

Please state the weight limit

Land Owner Details :

Land Access Payment Required

Value of Payment (£)

Additional notes

Overhead services

Additional photographs

Additional photos
Additional photo 1

Note

Additional photo 2

Note

Additional photo 3

Note

Additional photo 4

Note

Additional photo 5

Note

Additional photo 6

Notes

Pollution & environmental control

Identified Hazards, Environmental & pollution control

Damming Required

Type of Damming required

Pollution controls

Potential Bat Roost

Details of other environmental hazards identified

Site Specific and Equipment Required

Please describe the proposed method to complete the job

Is Jetting Required?

Type of Jetter

Describe access for jetter (good, reasonable, poor etc.

How much cable/suction hose is needed to reach the site?

Preferred Side of Survey

Sign off

Other comments ( minor works , observations etc

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.