Job Description

Services Supplies

Services Supplied

Purchase Order Number

Job Number

What is the Man-Hole / Line being worked on?

Who is the Onsite Supervisor/person responsible?

Time Arrived On Site
Time Departed Site
Client Approval

Notes: (eg. Work completed, reinstatement to occur in 2 weeks, as per Gavin's request.)

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.