Title Page
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Report Date
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Prepared by
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Location
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Job Number
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Client
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Permit Number
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Job Address
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Type Of Work
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Blockage Number
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Confirm Site Risk Assessment Complete
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Screenshot of GIS & Risk Assessment
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Pre-Work Dig Area
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Full Site Set up (SLG, Permits etc.)
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Was TM, BSS or PBS used?
Work In Progress
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Open Excavation (Damaged or Missing Duct)
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Excavation Depth (Shown with measuring tape or Depth Gauge)
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Excavation Width (Shown with measuring tape or Depth Gauge)
Repair & Reinstatement
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Duct Repair Or New Duct (Showing Repair kits correctly fitted)
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Backfill & Compaction
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Reinstatement of wearing course (with Lines Repainted if Required)
Mapping/GIS
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GIS or A55 with Completed Works
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DFE or Compensation Event Required?
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Closing Dimensions (Length) in Meters
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Closing Dimensions (Width) in Meters
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Exact Dig Location
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Material
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Permanent or Temporary
Completion & Sign off
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A End Chamber Showing Rope In Duct
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B End Chamber Showing Rope in Duct
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Site Clear (All Materials/Rubbish Removed & Site Washed down)
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Is the Job Complete?
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Lead Operative Sign Off
Summary of Photo Evidence
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