Information
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Site conducted
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Location
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PN Number
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Issued on
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Issued to
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Issued by
General site observations
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Is there enough chapter 8 on site for work to start safely ?
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Has the POWRA and F91 been completed for site ?
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Does the site protect the public and provide safe passage/ alternative route (PROVIDE 2 PHOTOS)
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Does the site allow for safe flow of traffic as per 'Red Book'
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Is correct PPE being worn on site (PROVIDE PHOTO)
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Please select sevices identified from service drawings
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Please select services identified from visual inspection
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Please select services identified from CAT GENNY sweep in all phases
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Please select services identified from TRIAL HOLE
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If all questions have been answered “satisfactorily “please proceed to sign /authorise “permit to dig”
Additional comments / feedback
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Please provide any further relevant details not included , yours / gang feedback
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Please indicate any further action as a result of your audit
Signature
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Agent Please sign.
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Foreman please sign
