Drain Jetting

• Document No.

• Area To Be Cleaned

• Conducted on

  Date

• Prepared by

• Location
  Address

• Extra Info

Safety

• Does The Risk Assessment Cover All Risks

  Safe

  At Risk

  N/A

• If At Risk Has An On Site Risk Assessment Been Completed

• Has Safety Barriers, Cones and Tape Been Put Up

  Safe

  At Risk

  N/A

• Photo Of Safety Managment

  Media

• Is Correct PPE Being Worn

  Yes

  No

  N/A

Blockage

• Problem Cause of Blockage

• Photo of blockage before

  Media

• Photo of blockage after

  Media

• Has a tracer dye been put down the drain to check the flow

  Yes

  No

  N/A

• Has the blockage been cleared

  Yes

  No

  N/A

• On Site Supervisor

  Sign