Title Page
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Project Name
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Project No.
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Location
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Client / Site
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Conducted on
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Prepared by
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Day / Night?
Site Personnel Record
Site Personnel
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Personnel
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Name
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Type
- Supervisor
- Labourer
- Plant Operator
- Engineer
- Foreman
- Pipe Layer
- Truck Driver
- Traffic Controller
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Start Time
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Finish Time
Sub-contractors
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Add Subcontractor
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Company
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Name
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Type
- Supervisor
- Labourer
- Plant Operator
- Engineer
- Foreman
- Pipe Layer
- Truck Driver
- Traffic Controller
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Start Time
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Finish Time
Site Plant Record
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On-site Plant? (Select all that apply)
- Lining Truck
- CCTV
- Pantech Truck
- Flat Bed
- Crane Truck
- Tool Truck
- Excavator
- Tipper Truck
- Ute
- Traffic Control Ute
- Pump
- Generator
- Lighting Tower
- Other
Lining Truck/s
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Rego
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Kilometres
Add additional Lining Truck
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Rego
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Kilometres
CCTV
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Serial No./s
Add additional CCTV
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Serial No./s
Pantech Truck/s
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Rego
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Kilometres
Add additional Pantech Truck
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Rego
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Kilometres
Flat Bed/s
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Rego
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Kilometres
Add additional Flat Bed
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Rego
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Kilometres
Crane Truck/s
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Rego
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Kilometres
Add additional Crane Truck
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Rego
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Kilometres
Tool Truck/s
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Rego
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Kilometres
Add additional Tool Truck
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Rego
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Kilometres
Excavator/s
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Rego / No.
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Hours
Add additional Excavator
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Rego / No.
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Hours
Tipper Truck/s
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Rego
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Kilometres
Add additional Tipper Truck
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Rego
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Kilometres
Ute/s
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Rego
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Kilometres
Add additional Ute
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Rego
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Kilometres
Pump/s
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Serial No.
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Hours (If applicable)
Add additional pump
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Serial No.
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Hours (If applicable)
Generator/s
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Serial No.
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Hours (If applicable)
Add additional Generator
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Serial No.
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Hours (If applicable)
Lighting Tower/s
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Serial No.
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Hours (If applicable)
Add additional Lighting Tower
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Serial No.
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Hours (If applicable)
Other
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Equipment Type?
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Serial no. / Rego (if applicable)
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Hours / Kilometres (if applicable)
Add additional equipment
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Equipment Type?
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Serial no. / Rego (if applicable)
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Hours / Kilometres (if applicable)
Hired Equipment
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Add Hired Equipment
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Equipment Type?
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Serial No. (If applicable)
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Hours (if applicable)
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Supplier?
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To be returned by date?
Work Details
Site Establishment
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Site mobilisation and de-mobilisation time?
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Details on lengthy mobilisation and de-mobilisation times?
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Equipment unloaded and set-up?
- Lining Kubota
- Excavator
- Spool and skates
- Power packs
- Gantry
- Road plates
- Ventilation Fans
- Shoring
- Other
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Traffic control requirements?
- Standard (Interflow controlled)
- Shoulder closure
- Single lane Closure
- Contraflow
- Road closure
- Multi-lane closure
- Other
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No. of Traffic controllers used?
Completed Works
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Works Completed? (Select all that apply)
- Cleaning
- Preline CCTV
- Dig-up / Repair
- Relining
- Sealing / Interfit
- FCCTV
- Patching
- Civil works
- Other
Cleaning
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Add line
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Row Number?
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Was there any debris removal?
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Type of Debris?
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Amount of debris removed? (tonneage if weighed or amount of white bags filled)
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Photos of debris removed
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Was root-cutting required?
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Was warthogging required?
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Does the line require further cleaning?
Preline CCTV
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Add Line
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Row Number?
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CCTV'ed Length?
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No. of Junctions identified?
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Were there any defects identified that prevent lining?
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Has a dig-up sheet been completed and submitted to the Project Engineer?
Dig-up /Repair
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Add Repair
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Row Number?
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Type of Repair?
- Pipe section
- MH lid raise
- Manhole raise
- Manhole Build
- Dead end dig
- Other
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Details
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Depth of repair?
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Photos of repair
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Was restoration completed?
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Photos of restoration
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Additional works required?
Relining
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Add line
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Row Number?
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Was a jack out required?
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Time spent on jack out?
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Was plugging required?
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Has the Flow management plan been reviewed, endorsed and followed?
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Flow management type?
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Has the bypass pump been accounted for in the site plant record?
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Size of bypass pump and hose?
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Length of bypass?
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Spool Number?
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Spool starting meterage?
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Spool finishing meterage?
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Junctions cut?
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Additional works required?
Sealing / Interfit
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Add Line
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Row Number?
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No. of Junctions Sealed?
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No. of junctions remaining to be sealed?
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Additional works required?
FCCTV
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Add line
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Row Number?
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CCTV'ed length
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No. of junctions?
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Any defects present?
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Defect details
Patching
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Add line
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Row Number?
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No. of patches installed?
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Additional works required?
Civil works
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Type of works?
Other
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Details of work?
Sign Off
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Completed By