Title Page

  • Site conducted

  • Prepared by

  • Conducted on

  • Address

  • GPS Location
  • Number of meters inspected at location?

  • Operating Company

  • Service Center

  • Service Center

  • Service Center

  • Asset ID(Meter Number)

  • Meter install date

  • Work Order Number

  • Service line install date

  • Service line install Foreman

  • Photo

  • Is the meter installed?

  • Is the XE shutoff valve locked?

  • Is there a plug or cap installed?

  • Is there a customer valve installed?

  • Is the customer piping connected?

  • Is there a plug or cap installed?

  • Is the shutoff valve accessible?

  • Is above-ground piping properly coated?

  • Is there at least a 3-foot radius clearance between the regulator vent and the building opening? (Should)

  • Is the meter regulator no less than 3 feet from a source of ignition or heat?

  • Is there at least a 6-foot radius clearance between the regulator vent and the building mechanical air intake?

  • Is the vent on the regulator insect and rain-resistant?

  • Is the meter protected from vehicular traffic?

  • In new construction, is the meter at least 6 inches above the final grade(Should)

  • Is the meter in contact with the soil?

  • Is the meter properly supported?

  • Is the meter straight and level?

  • Is the meter protected from overhead hazards?

  • Other Concerns?

  • What is the concern?

  • What is the concern?

  • What is the concern?

  • What is the concern?

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.