Title Page

  • DoC Works Order Number:

  • Property ID

  • Property Address:
  • Conducted on:

  • Conducted by:

ASSESMENT: Refer Technical Specifications cl.169.2

Property Sewer system:

  • Type:

  • Location of Inspection Shaft i.e. Front (RHS) Rear (LHS)

  • Photograph

  • Number and location of Septic Tanks and Leach Drains

  • Photograph

  • Brand/Location/Irrigation System i.e. sprinkler field

  • Photograph

  • If 'OTHER', description required.

  • Photograph

Cause of Blockage:

  • Issue

  • Has the drain been compromised (damaged)?

  • Description and location.

  • Description


As-Constructed Attachment:

  • Please attach image of the 'As-constructed' property drainage layout. The attachment must clearly show; location of blockage and, where applicable, location of Septic tanks, leach drain(s), ATU and irrigation field. Refer example below.

    As_Constructed example.png
  • Add media


  • Check box if additional works are required. (Where additional works are identified, to ensure the adequate functioning of the property drainage system, the Contractor is to immediately inform the Principal and request an Additional Works Order under Clause 4.7 of the General Specification).

Schedule of Rates:

  • SoR required

  • Description

  • Location

  • Quantity

Non SoR labour:

  • Tick the box where non scheduled labour is required to complete the works.

  • Describe why the non schedule labour is required

  • Units of labour (per 1/4 HR increments)

Non SoR material:

  • Tick the box where non scheduled material is required to complete the works.

  • Material description

  • Quantity

  • Costings

Non SoR Works - Plant and Equipment:

  • Check the box where non scheduled Plant and/or Equipment is required to complete the works.

  • Plant/Equipment description

  • Costings


  • Has a Hazard been identified? [A hazard is anything with the potential to cause injury or property damage].

  • Recommended Actions

  • Photograph

Additional Comments

  • Is further Technical Information required

  • Comments

License No

  • Please provide Trade License details


  • Please sign on completing the Audit

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