I report form

SAP details

• SAP Number:

• Maximo Work Order

• Address

• Conducted on

  Date

• Personnel

Work Order Details

• Work order number inc. operation number

• On Site Time:

  Date

• Actual finish time

  Date

Cause of Incident

• CAUSE of Incident

  Select Storm Blockage Collapse Equipment Failure Nothing Found Manhole Cover Unknown At Time Pseudo-Collapse

  • Storm
  • Blockage
  • Collapse
  • Equipment Failure
  • Nothing Found
  • Manhole Cover
  • Unknown At Time
  • Pseudo-Collapse

• CAUSE of Blockage (if appropriate)

  Select Silt Interceptor Roots Sanitary Fat Debris Other

  • Silt
  • Interceptor
  • Roots
  • Sanitary
  • Fat
  • Debris
  • Other

• CAUSE Asset Type

  Select Foul Sewer Vacuum Sewer System Combined Sewer Penstock Surface Water Pipe Telemetry Former S24 Sewer Oil Interceptor SPS Chemical Dosing Rising Main STW Distribution Asset CSO Non STW Asset - Private NRV Non STW Asset - Counsil Storage Tank Non STW Asset - Other Flow Control Device

  • Foul Sewer
  • Vacuum Sewer System
  • Combined Sewer
  • Penstock
  • Surface Water Pipe
  • Telemetry
  • Former S24 Sewer
  • Oil Interceptor
  • SPS
  • Chemical Dosing
  • Rising Main
  • STW Distribution Asset
  • CSO
  • Non STW Asset - Private
  • NRV
  • Non STW Asset - Counsil
  • Storage Tank
  • Non STW Asset - Other
  • Flow Control Device

• If other please state:

• Weather Conditions (at time of Incident)

  Dry

  Rain

  Drizzle

  Heavy Rain

Grid reference - DO NOT USE - Phone

• Grid reference (NGR):

• PDaS related

• Pipe Reference (UID of CAUSE)

• DAS Code

• 3rd Party Comments:

Comments e.g. - Rodded/ Jetted u/s-d/s from manhole X to Y. - Dye tested cellar - Washed down and disinfected - Cleaned up

Activity Type

• Activity Type

  Inspection

  CCTV

  Cleanup

  Blockage Clear

  Blockage Clear with CCTV

• FOW Required? If yes- fill in FOW request form

  Yes

  No

  N/A

JOB ADDRESS/LOCATION DETAILS

• Occupier's Name/Telephone Number

• Property Name/Number

• Address (Line 1)

• Address (Line 2)

• Address (Line 3)

• Postcode

Property Type

• Property Type

  Select Domestic Industrial Commercial Shop Hospital School Other

  • Domestic
  • Industrial
  • Commercial
  • Shop
  • Hospital
  • School
  • Other

• If other please state:

Escape of Sewage

• Did Sewage Escape- if yes fill in escape of sewage section below

  Yes

  No

  N/A

• Where did Sewage escape from:

• Duration of Escape

  Select <1 1-4 4-8 8-12 12-24 >24

  • <1
  • 1-4
  • 4-8
  • 8-12
  • 12-24
  • >24

• Area Covered (m)

  Non Visible

  <2

  2-4

  5-10

  >10

• Depth

  Non Visible

  <1

  1 - 3

  3 - 6

  >6

• How long did clean up take (mins)

  Not done

  <15

  >15

Photo's - please attach photos to submission

• Take PHOTOS

• How many photos have you taken?

Additional Information

• Did escape cause external damage?

  Yes

  No

• If yes comment:

• Access restricted?

  Yes

  No

• If yes comment:

• Usage restricted?

  Yes

  No

  N/A

• If yes comment:

• Did sewage enter the building?

  Yes

  No

• If yes comment:

• Damage to fixtures and fittings?

  Yes

  No

  N/A

• If yes comment:

For all incidents

Incident at location

INITIAL INSPECTION

• Primary

  Select Flooding Escape of Sewage RTU Surcharge Smell Noise Nuisance Safety Pollution

  • Flooding
  • Escape of Sewage
  • RTU
  • Surcharge
  • Smell
  • Noise
  • Nuisance
  • Safety
  • Pollution

• Secondary 1

  Select Flooding Escape of Sewage RTU Surcharge Smell Noise Nuisance Safety Pollution

  • Flooding
  • Escape of Sewage
  • RTU
  • Surcharge
  • Smell
  • Noise
  • Nuisance
  • Safety
  • Pollution

• Secondary 2

  Select Flooding Escape of Sewage RTU Surcharge Smell Noise Nuisance Safety Pollution

  • Flooding
  • Escape of Sewage
  • RTU
  • Surcharge
  • Smell
  • Noise
  • Nuisance
  • Safety
  • Pollution

Affected Area

• Primary

  Select Main building Cellar - inhabited Cellar - uninhibited Integral garage Detached garage/ outbuilding Garden / Driveway Highway / Footpath Public Area Field Watercourse

  • Main building
  • Cellar - inhabited
  • Cellar - uninhibited
  • Integral garage
  • Detached garage/ outbuilding
  • Garden / Driveway
  • Highway / Footpath
  • Public Area
  • Field
  • Watercourse

• Secondary 1

  Select Main building Cellar - inhabited Cellar - uninhibited Integral garage Detached garage/ outbuilding Garden / Driveway Highway / Footpath Public Area Field Watercourse

  • Main building
  • Cellar - inhabited
  • Cellar - uninhibited
  • Integral garage
  • Detached garage/ outbuilding
  • Garden / Driveway
  • Highway / Footpath
  • Public Area
  • Field
  • Watercourse

• Secondary 2

  Select Main building Cellar - inhabited Cellar - uninhibited Integral garage Detached garage/ outbuilding Garden / Driveway Highway / Footpath Public Area Field Watercourse

  • Main building
  • Cellar - inhabited
  • Cellar - uninhibited
  • Integral garage
  • Detached garage/ outbuilding
  • Garden / Driveway
  • Highway / Footpath
  • Public Area
  • Field
  • Watercourse

• None

• Comments for this location:

Customer information

• Customer informed of work carried out?

  Yes

  No

  N/A

• If yes please comment:

• Bag it & bin it leaflets issued?

  Yes

  No

  N/A

• Customer called prior?

  Yes

  No

  N/A

• Floodcare leaflet issued/ explained?

  Yes

  No

  N/A

• Incident feedback form issued explained?

  Yes

  No

  N/A