Title Page
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Clerk of Works Site Surveillance Form
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Job Number 31/34069/06
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Contract Number: FCEC2001.01
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Project: Falls Creek Eagle Chair Replacement
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Contractor: Leitner Poma of America
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Surveillance Officer:
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Site Supervisor:
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Arrival Time:
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Departure Time:
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Date:
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Exact Location:
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Work Item(s) Being Inspected:
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General Site Observations including Plant/Equipment and Labour on Site:
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Any Defective Work and Materials; and Non-Compliances?
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List items that are defective and/or non-compliant
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Add Photo (if possible)
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Any test results received/observed?
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List any test results:
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Any Hold/Witness Points Reached?
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Add details of Hold/Witness Points:
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Add Photos
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Quality of Work:
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Any Delays to Works and/or Potential Delays (wet weather, waiting on works by others, industrial action, latent conditions, etc)?
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List Delay(s) (and expected time if know)
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Any Environmental, OH&S, Industrial Relations Issues?
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List Issues
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Photo (if required)
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Any verbal directions given to the contractor?
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Note any verbal instructions given to the Contractor:
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Is a Notice of Proposed Variation, Variation Order or Site Instruction Required?
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If Yes, Provide Details
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Further Inspection and/or Testing Required on Work Item(s) Listed Above
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Photographs Taken?
List Photos and Location/Item
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Add media
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Contractors Verification Records
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If Incomplete or Non Existent list/document actions required
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Weather Conditions:
- Fine
- Overcast
- Light Rain
- Heavy Rain
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Other Comments
