Site specifics

Geo tag location of works to be carried out (may differ from IMR form)
Please take photos of site applicable to works location and comment.


Please select TM requirements

Please add any additional TM requirements here.

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Please select road speed and applicable road type.


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Please enter ground conditions at observed ground level.

Please add any additional info.


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Depth to pipe
Assumed depth of excavation
Meterage of repair
Flow %
Pipe size
Pipe material

Please enter MH cover size

If non standard size please add info.


Photos of cover (with tape measure also)
Sewer type
Sewer system

Job requiements

Site Hazards identified

Please comment where applicable


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Environmental and other hazards.

Please comment where applicable

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Additional site photos

Photo information

Add signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.