Information

  • Job Type

  • Contract

  • Company who originally carried out the work

  • Team Name

  • Conducted on

  • Supervisor Name

  • PN / NBU - Number to be completed on blockages Only

  • Build Area

  • please state the Tube House number for this blockage report, if multiple tubes house numbers are in the same excavations please state each house number

  • Street Name
  • Please put House Number or Land Mark location for Blockage / Fault or De-Silk.

  • Please take a photo showing location more than one can be taken

Job Details

  • Who is Completing the Blockage / Fault / De-Silk

  • Please select Work Type i.e De-silk, Blockage, Toby in wrong position, Tube short in Cab, Tubes short in Toby.

  • Please select surface type of Fault i.e, Footway Tarmac, Footway Flags, Footway Concrete, Footway Blocks, Verge, Carriageway Blocks, Carriageway Concrete, Carriageway Tarmac.

  • Please take a Photo Showing surface Type of Fault 1

  • Are Tubes laid to the Correct Depth

  • Please Type the Depth Measurement for Fault 1 Location i.e 250mm

  • Please take Photo showing a measurement of Tubes Depth at Fault 1 Location more than one can be taken

  • How many Tubes are Damaged

  • How many Connectors have been used

  • Please take Photo showing repaired Tubes at Fault 1 Location more than one can be taken

  • Fault 1 Location, Excavation Dimensions

  • Type of Damage to the tube's

  • Reinstated as PERM or INTRIM

  • DO YOU REQUIRE TO COMPLETE A SECOND FAULT LOCATION

  • Please select surface type of Fault i.e, Footway Tarmac, Footway Flags, Footway Concrete, Footway Blocks, Verge, Carriageway Blocks, Carriageway Concrete, Carriageway Tarmac.

  • Please take a Photo Showing surface Type of Fault 2

  • Please put House Number or Land Mark location for Fault 2

  • Please take a photo showing location more than one can be taken

  • Are Tubes laid to the Correct Depth

  • Please Type the Depth Measurement for Fault 2 Location i.e 250mm

  • Please take Photo showing a measurement of Tubes Depth at Fault 2 Location more than one can be taken

  • How many Tubes are Damaged

  • How many Connectors have been used

  • Please take Photo showing repaired Tubes at Fault 2 Location more than one can be taken

  • Fault 2 Location, Excavation Dimensions

  • Type of Damage to the tube's

  • Reinstated as PERM or INTRIM

  • DO YOU REQUIRE TO COMPLETE A THIRD FAULT LOCATION

  • Please select surface type of Fault i.e, Footway Tarmac, Footway Flags, Footway Concrete, Footway Blocks, Verge, Carriageway Blocks, Carriageway Concrete, Carriageway Tarmac.

  • Please take a Photo Showing surface Type of Fault 3

  • Please put House Number or Land Mark location for Fault 3

  • Please take a photo showing location more than one can be taken

  • Are Tubes laid to the Correct Depth

  • Please Type the Depth Measurement for Fault 3 Location i.e 250mm

  • Please take Photo showing a measurement of Tubes Depth at Fault 3 Location more than one can be taken

  • How many Tubes are Damaged

  • How many Connectors have been used

  • Please take Photo showing repaired Tubes at Fault 3 Location more than one can be taken

  • Fault 3 Location, Excavation Dimensions

  • Type of Damage to the tube's

  • Reinstated as PERM or INTRIM

  • DO YOU REQUIRE TO COMPLETE A FOURTH FAULT LOCATION

  • Please select surface type of Fault i.e, Footway Tarmac, Footway Flags, Footway Concrete, Footway Blocks, Verge, Carriageway Blocks, Carriageway Concrete, Carriageway Tarmac.

  • Please take a Photo Showing surface Type of Fault 4

  • Please put House Number or Land Mark location for Fault 4

  • Please take a photo showing location more than one can be taken

  • Are Tubes laid to the Correct Depth

  • Please Type the Depth Measurement for Fault 4 Location i.e 250mm

  • Please take Photo showing a measurement of Tubes Depth at Fault 4 Location more than one can be taken

  • How many Tubes are Damaged

  • How many Connectors have been used

  • Please take Photo showing repaired Tubes at Fault 4 Location more than one can be taken

  • Fault 4 Location, Excavation Dimensions

  • Type of Damage to the tube's

  • Reinstated as PERM or INTRIM

  • DO YOU REQUIRE TO COMPLETE A FIFTH FAULT LOCATION

  • Please select surface type of Fault i.e, Footway Tarmac, Footway Flags, Footway Concrete, Footway Blocks, Verge, Carriageway Blocks, Carriageway Concrete, Carriageway Tarmac.

  • Please take a Photo Showing surface Type of Fault 5

  • Please put House Number or Land Mark location for Fault 5

  • Please take a photo showing location more than one can be taken

  • Are Tubes laid to the Correct Depth

  • Please Type the Depth Measurement for Fault 5 Location i.e 250mm

  • Please take Photo showing a measurement of Tubes Depth at Fault 5 Location more than one can be taken

  • How many Tubes are Damaged

  • How many Connectors have been used

  • Please take Photo showing repaired Tubes at Fault 5 Location more than one can be taken

  • Fault 5 Location, Excavation Dimensions

  • Type of Damage to the tube's

  • Reinstated as PERM or INTRIM

  • Please take Photos Before and After De-Silk

  • How Many Hours to complete De-Silk

Conclusion

  • Person Name Carrying Out Repair

  • Report Complete and Correct

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