Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Pre Start #

  • TMP #

  • Hazardous Task #

  • Contractor Group

  • Stage of Work

HSE CHECKLIST

  • Administrative Controls

  • Site Housekeeping & Materials

  • PPE & First Aid

  • Public Protection

  • Manual Handling

  • Prevention Of Falls

  • Mobile Plant & Equipment

  • Electrical

  • Excavation / Boring / Trenching

  • Welding

  • Confined Space

TECHNICAL CHECKLIST

  • Operators Authorised in Critical Skills

CONSTRUCTION

  • Depth Of Cover

  • Boring

  • Clearances Between Assets

  • Insertion

  • Pipe Jointing

  • Tracer Wire / Marker Tape

  • Service Riser

  • Pipe Bedding

  • Backfill & Reinstatement

  • Pressure Testing

  • Tie in to Existing Mains

  • Protection of Bare Steel

  • Testing of Steel Pipe Coating

  • Internal Cleaning of Pipes

  • Pipeline Markers

  • Recording of Services

CONNECTION

  • Meter Installation

  • Meter Change / Regulator Change

  • Meter Locks

  • Supply Investigation

  • Refix Relight

  • Other

MAINTENANCE

  • Escape Investigation

  • Escape Repair

  • Alteration Main / Service

  • Pipeline Patrol / Inspection

  • Other

  • Field Issues Number ( where NCR is raised)

  • Comments

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.