Information

  • Enter the last 7 digits of the TOW number ( eg 2088443)

  • Time and date of the audit

  • Prepared by (your full name)

  • What is the TOW Address

  • Activation Date

LIC and Audit Data

  • Civil Capture Data Sheet

INSTALL DETAILS

  • 1.Enter all fields applicable to civil install

  • Install Type

  • PCD Installed

  • Take photo of PCD

  • Tether Size Installed from MPT to PCD

  • Trench meterage ( PIT - PCD )

  • Enter trench meterage completed

  • Take some supporting photos.

  • Grundomat ( Under Bore ) Required

  • Enter meterage for bore 1

  • Enter meterage for bore 2

  • Enter meterage for bore 3

  • Take some supporting photos.

  • Concrete Breakout / Reinstatement

  • Enter the length of breakout / reinstatement

  • Enter the width of breakout / reinstatement

  • Take some supporting photos.

  • Paver Breakout / Reinstatement

  • Enter the length of breakout / reinstatement

  • Enter the width of breakout / reinstatement

  • Take some supporting photos.

  • Bitumen Breakout / Reinstatement

  • Enter the length of breakout / reinstatement

  • Enter the width of breakout / reinstatement

  • Take some supporting photos.

  • Core Bore Wall

  • How many core bores were completed

  • Take a photo of core bores

  • Core Bore Perimeter Path

  • How many core bores were completed

  • Take a photo of core bores

  • Asbestos

  • ACM P20 Break Out Completed

  • Take photo of pit before breakout

  • Take photo of pit after breakout

  • Take photo of ACM bag with tag clearly visible

Audit Closure

CIVIL CAPTURE CLOSURE

  • By signing the below I agree that the civil install has been completed to depth ( 300mm inside boundary & 450mm outside boundary ), and job site has been left in a tidy and satisfactory manner

  • Civil Team Leader Sign Off

  • Date

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.