Title Page

  • Conducted on

  • Prepared by

  • Location
  • Gang ID

  • Job Reference

Job Description

  • Work Type

Excavation Size

  • Width

  • Length

Site General

  • Does site comply with 'Safety at Streetworks' CoP (Photo Required)

  • Does Site have Information Board and Permit number

  • Is appropriate uniform/PPE being Used Flame retardant/dust masks etc

Apparatus/Backfill/Sub-base

  • Apparatus to correct depth (Photo Required)

  • Apparatus to correct configuration (Photo Required)

  • MOT Type 1 on site

  • Sand on site

Material for backfill

  • Type 1

  • Sand

  • Other

  • Correct compaction equipment used

  • Correct depth left for asphalt

Blacktop

  • Edges trimmed and sealed 2 applications

  • Tack coat used carriageways

  • Base course complies with specification

  • Correct compaction equipment used for base material (Trench wacker)

  • Surface course complies with specification

  • Correct compaction equipment used for surface course

Notes/Comments

  • undefined

Remedials Required

  • undefined

Signed

  • Auditors Signature

  • Team Leader Signature

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.