Title Page
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Client Name
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PIA NOI Number
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Siebel Reference Number
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GES Reference Number
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Build Area (i.e., Colne, Ilkley)
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PN & Asset Affected (i.e PN06 ASN12)
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Location
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Completed By
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Contact Number
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Date/Time Recorded
Repair Details
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Dig in Public Highway or Private Location
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Permit Number
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Site set up and SLG
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Is blockage Duct or Pole Bend
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Blockage Eastings
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Blockage Northings
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Take photo of the Pre-dig blockage area where 'X' marks the spot at base of pole (from A55) and context of the surrounding area.
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Photo of open excavation showing extent of damaged/missing pole bend duct.
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Photo of open excavation with damage and associated open link chamber and context of surrounding area
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Photo of repaired pole bend duct close up. NOTE: 1) ALL existing pole cables must be inside the repair, 2) cable ties/straps must be secured every 10cm, 3) If a duct 54 pole bend (2") meets duct 56 (4") before a chamber, a split reducing collar MUST be used.
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Photo of repaired pole bend and context of surrounding area
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Photo of reinstatement close up.
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Photo of reinstatement and context of surrounding area. NOTE: MUST include Connector Bend in photo (Elephants foot) If damaged or lost you MUST REPLACE it.
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Works completed and site clear date & time
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Signature
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Blockage Eastings
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Blockage Northings
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Take photo of the Pre-dig blockage area where 'X' marks the spot (from A55) and context of the surrounding area.
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Photo of open excavation showing extent of damaged/missing duct.
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Photo of excavation showing damaged/missing duct and context of the surrounding area.
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Photo of duct repaired close up. NOTE: The photo must show visible split collars on BOTH SIDES of the repair and cable ties/straps tied every 10cm.
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Photo of duct repaired and context of surrounding area.
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Photo of completed reinstatement close up.
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Photo of completed reinstatement and context of surrounding area.
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Works completed and site clear date & time
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Signature
