Title Page

  • Project Name

  • Project No.

  • Location
  • Client / Site

  • Conducted on

  • Prepared by

  • Day / Night?

Site Personnel Record

Site Personnel

    Personnel
  • Name

  • Type

  • Start Time

  • Finish Time

  • Hours

Sub-contractors

    Add Subcontractor
  • Company

  • Name

  • Type

  • Start Time

  • Finish Time

  • Hours

Site Plant Record

  • On-site Plant? (Select all that apply)

Lining Truck/s

  • Rego

  • Kilometres

  • Add additional Lining Truck
  • Rego

  • Kilometres

CCTV

  • Serial No./s

  • Add additional CCTV
  • Serial No./s

Pantech Truck/s

  • Rego

  • Kilometres

  • Add additional Pantech Truck
  • Rego

  • Kilometres

Flat Bed/s

  • Rego

  • Kilometres

  • Add additional Flat Bed
  • Rego

  • Kilometres

Crane Truck/s

  • Rego

  • Kilometres

  • Add additional Crane Truck
  • Rego

  • Kilometres

Tool Truck/s

  • Rego

  • Kilometres

  • Add additional Tool Truck
  • Rego

  • Kilometres

Excavator/s

  • Rego / No.

  • Hours

  • Add additional Excavator
  • Rego / No.

  • Hours

Tipper Truck/s

  • Rego

  • Kilometres

  • Add additional Tipper Truck
  • Rego

  • Kilometres

Ute/s

  • Rego

  • Kilometres

  • Add additional Ute
  • Rego

  • Kilometres

Pump/s

  • Serial No.

  • Hours (If applicable)

  • Add additional pump
  • Serial No.

  • Hours (If applicable)

Generator/s

  • Serial No.

  • Hours (If applicable)

  • Add additional Generator
  • Serial No.

  • Hours (If applicable)

Lighting Tower/s

  • Serial No.

  • Hours (If applicable)

  • Add additional Lighting Tower
  • Serial No.

  • Hours (If applicable)

Other

  • Equipment Type?

  • Serial no. / Rego (if applicable)

  • Hours / Kilometres (if applicable)

  • Add additional equipment
  • Equipment Type?

  • Serial no. / Rego (if applicable)

  • Hours / Kilometres (if applicable)

Hired Equipment

    Add Hired Equipment
  • Equipment Type?

  • Serial No. (If applicable)

  • Hours (if applicable)

  • Supplier?

  • To be returned by date?

Work Details

Site Establishment

  • Site mobilisation and de-mobilisation time?

  • Details on lengthy mobilisation and de-mobilisation times?

  • Equipment unloaded and set-up?

  • Traffic control requirements?

  • No. of Traffic controllers used?

Completed Works

  • Works Completed? (Select all that apply)

Cleaning

    Add line
  • Row Number?

  • Was there any debris removal?

  • Type of Debris?

  • Amount of debris removed? (tonneage if weighed or amount of white bags filled)

  • Photos of debris removed

  • Was root-cutting required?

  • Was warthogging required?

  • Does the line require further cleaning?

Preline CCTV

    Add Line
  • Row Number?

  • CCTV'ed Length?

  • No. of Junctions identified?

  • Were there any defects identified that prevent lining?

  • Has a dig-up sheet been completed and submitted to the Project Engineer?

Dig-up /Repair

    Add Repair
  • Row Number?

  • Type of Repair?

  • Details

  • Depth of repair?

  • Photos of repair

  • Was restoration completed?

  • Photos of restoration

  • Additional works required?

Relining

    Add line
  • Row Number?

  • Was a jack out required?

  • Time spent on jack out?

  • Was plugging required?

  • Has the Flow management plan been reviewed, endorsed and followed?

  • Flow management type?

  • Has the bypass pump been accounted for in the site plant record?

  • Size of bypass pump and hose?

  • Length of bypass?

  • Spool Number?

  • Spool starting meterage?

  • Spool finishing meterage?

  • Junctions cut?

  • Additional works required?

Sealing / Interfit

    Add Line
  • Row Number?

  • No. of Junctions Sealed?

  • No. of junctions remaining to be sealed?

  • Additional works required?

FCCTV

    Add line
  • Row Number?

  • CCTV'ed length

  • No. of junctions?

  • Any defects present?

  • Defect details

Patching

    Add line
  • Row Number?

  • No. of patches installed?

  • Additional works required?

Civil works

  • Type of works?

Other

  • Details of work?

Sign Off

  • Completed By

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