Title Page

  • Scheme Name

  • Scheme Number

  • Protection Type

  • TR locations
  • TR Name

  • TR Location
  • Pressure Rating

  • Survey Date

  • Survey Type

  • Surveyed By

  • Email

  • Contact Number

Fault Details

    Add Fault
  • Test Post Number

  • Location
  • On Potential (mV)

  • Off Potential (mV)

  • Fault Description

  • Remediation Action Required

  • Anode Reading (mV)

  • Anode Current

  • Deadside Reading (mV)

  • Liveside Reading (mV)

  • Coupon Reading (mV)

  • Is the test post in grass verge, tarmac footpath, tarmac road, flagged footpath, concrete footpath, block paving, public or private land?

  • Other considerations e.g. railway crossings, bridges, dual carriageways etc?

  • Is traffic management required e.g. Lane closure, 2 way temporary traffic lights?

  • Does the test post need relocating?

  • UpTime Amendment/s Required

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.