Title Page

  • Feature ID

  • Exchange

  • Date

  • Gang Lead

  • Location

Health & Safety

  • Have You Completed A Risk Assessment

  • Provide Photo of Completed POWRA

Pre-Site

  • Pre-Site photos including any existing damage

  • Mark Up Photos including aspect view (NOT JUST A CLOSE UP)

  • Site Set-up photos from each direction

Build Evidence

  • Photos of Frame & Cover Before, During, After (include pics of Removal & clean surface before new fitting, show cement based bedding (max 50mm depth), sealing, levels to proximities, New frame and Lids installed)

  • Photos of backfill including aspect view and clearly showing cutbacks & proximities (NOT JUST A CLOSE UP)

  • Reinstatement photos including concrete surround where applicable and aspect view (NOT JUST A CLOSE UP)

Job Completion

  • Dig dimensions & Surface Type: length, Width and Surface Type of dig (e.g L 1.7m x W 1.2m, Tar F/w)

  • Exact Address of Dig (Try to be as specific as possible) Example 1: O/s 23 Cherry Close. Example 2: Near 14 High Street, on Junction of Elm Street.

  • Comments / Outcome

Confirmation

  • Site Clear or Left Safe Ready For Reinstatement Photos

  • Gang Lead Signature

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.