Danny White

CAT Scan Record

Utility Surveyor assessment form

Use this Template

Print as PDF

Use this Template

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Title Page

P.O or work order reference.
Location
Conducted on
Surveyor
Permit No
CAT equipment Serial No
Genny serial no.
GPR serial no.
Location

Job Phase
- Design
- Build
Have all stats/drawings been provided?
Generic Risk Assessment Numbers
Weather during Survey
- Dry
- Wet
- Icey
- Windy
- Hot
Ground conditions during survey
- Hard
- Soft

SERVICES FOUND

List services
Service photo 1
Service photo 2
Service photo 3
Service photo 4
Service photo 5
Service photo 6
Service photo 7
Service photo 8
Service photo 9
Service photo 10
Comments
Signature of CAT Operator
Signature of Site Agent
Signature of Lead Operative

Danny White

CAT Scan Record

Utility Surveyor assessment form

Use this Template

Print as PDF

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.