City of Bixby

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Site preparedness

• Select date

  Date

• Underground utilities marked in dig site

  Yes

  No

  N/A

• Site is clear of obstructions

  Yes

  no

• Site photo

  Media

• Appropriate equipment is on site

  Yes

  no

• Equipment is fueled and ready for use

  Yes

  no

• Truck is stocked with appropriate parts

  Yes

  no

• Personnel on site to make repairs

Leak

• Leak type

  Service line

  main line

• Cause of leak

• Parts used to make repair

• Pipe repair photo (if available)

  Media

Completetion of work

• Dig site is backfilled

  Yes

  no

• If dig site left open were appropriate safety barricades left to notify public of hazard

  Yes

  no

• All tools and hand equipment picked up and returned to appropriate truck

  Yes

  no

• All valves returned to open

  Yes

  no

• If no which valves remain closed

• Site photo after completion of work

  Media