• Original Job Sheet Number

  • Prepared by

  • Site

  • Gate Location / Number

  • Date of Inspection

  • If job/reactive is not complete (ie system is not left fully working) this sheet must be completed


  • How has system been left?

  • Brief description of work required to return to full function

  • Part name must either be number from parts list or detail of manufacturer/supplier and make/model

  • Parts required (including cables, conduits and making good materials - quantities and parts numbers required)

  • If more than one gate leaf, describe leaf from inside premises looking out

  • If pedestrian gate or single leaf, please describe hinge side and lock side from inside premises looking out

Labour required

  • Senior Engineer

  • Number of engineers / hours per person

  • Labourer / fitter

  • Number of operatives / hours per person

  • Specialist

  • Number of engineers / hours per person

  • Other

  • Number of operatives / hours per person


  • Cable / conduit required

  • Please note distances and route type (ie where clipped, where to cut into concrete/Tarmac/soft dig and any other details to describe the method required for this work)


  • Take photos of routes (start to finish) and all relevant junction points and start/finish positions

  • Photographs

Other Information

  • Note any particular issues or difficulties



  • I/we confirm that the information included in this status report is correct at time of survey

  • Surveyor 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.