CRM INSPECTION REPORT - STORMWATER DRAINAGE

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

DATA

• Location:
  Address

• Complaint Type

  Customer request

  Referral from within council

  Work permit application

  Other

  Routine inspection

• CRM No.

• Drainage Type

  Select Table drain / swale Kerb and gutter Piped drainage Culverts Over land water flow from council property Over land water flow from private property Inter-allotment drainage Natural creek / watercourse GPT Wetland Bioretention Sand filter Rain garden Other Canal

  • Table drain / swale
  • Kerb and gutter
  • Piped drainage
  • Culverts
  • Over land water flow from council property
  • Over land water flow from private property
  • Inter-allotment drainage
  • Natural creek / watercourse
  • GPT
  • Wetland
  • Bioretention
  • Sand filter
  • Rain garden
  • Other
  • Canal

• Hazard Type

  Select Subsidence of ground surface Ponding of storm water runoff Impeding flow of water / blockage Vehicle or property damage Pedestrian personal injury Damaged public infrastructure Flooding - private property Flooding - public property Pollution Overgrown vegetation Vermin Damaged private infrastructure N/A Erosion

  • Subsidence of ground surface
  • Ponding of storm water runoff
  • Impeding flow of water / blockage
  • Vehicle or property damage
  • Pedestrian personal injury
  • Damaged public infrastructure
  • Flooding - private property
  • Flooding - public property
  • Pollution
  • Overgrown vegetation
  • Vermin
  • Damaged private infrastructure
  • N/A
  • Erosion

• What has occurred?

• Has this occurred before?

  Yes

  No

  N/A

• When?

• Site photographs

  Media

• CRM Risk assessment required?

  Yes

  No

  N/A

• RISK RATING

• 

• Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Certain

• 

• Consequences

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• 

• OVERALL RISK ASSESSMENT

  LOW

  MEDIUM

  HIGH

  VERY HIGH

ADDITIONAL ASSESSMENT CRITERIA

• PEDESTRIAN AND/OR VEHICLE USAGE

• High Use - CBD areas, shopping centers, aged care facilities, Hospitals, Schools

  Yes

  No

  N/A

• Medium Use - Parks adjoining High areas, churches and aged homes within urban areas; all medium or high density residential zones; strip shops or corner shops in residential areas. In parks, reserves and lane ways with unlimited access.

  Yes

  No

  N/A

• Low Use - All other areas.

  Yes

  No

  N/A

OUTCOMES & ACTIONS

• What is the outcome?

  No action required

  Refer to maintenance coordinator for action

  Refer to drainage engineer for detailed investigation

  emergency response works required ASAP

  Refer to other

• Referral details

• Who to refer to:

• Scope of referral:

• Advise provided to complainant

• Scope of works

• Scope of works

ADDITIONAL RISK ASSESSMENT

• EVALUATION CRITERIA
  0 - not affected
  1 - low risk. Affected in less frequent storm events. 1 in 100 years or RARELY
  2 - medium risk. Affected in mid range storm events. Say 1 in 10 to 1 in 50 years or OCCASIONALLY
  3 - high risk. Affected in frequent storm events. Say less than 1 in 5 years or FREQUENTLY

• EVALUATION CRITERIA
  0 - not affected
  1 - low risk. Affected in less frequent storm events. 1 in 100 years or RARELY
  2 - medium risk. Affected in mid range storm events. Say 1 in 10 to 1 in 50 years or OCCASIONALLY
  3 - high risk. Affected in frequent storm events. Say less than 1 in 5 years or FREQUENTLY

• Risk of life

  0

  1

  2

  3

• Habitable floor inundation

  0

  1

  2

  3

• Property / non-habitable floor habitation

  0

  1

  2

  3

• Velocity / depth hazard

  0

  1

  2

  3

• Potential damage - private property

  0

  1

  2

  3

• Potential damage - public property

  0

  1

  2

  3

• Number of properties affected<br>0 - 0 properties<br>1 - 1 property<br>2 - 2-5 properties<br>3 - >5 properties

  0

  1

  2

  3

ADDITIONAL INFORMATION

• Any additional information?

• Additional photographs:

  Media

• Inspectors Name

  Sign