Title Page

  • Conducted on

  • Prepared by

Customer information

  • Address
  • Customer name

  • Customer telephone number

Job information

  • Job description

  • Mains material

  • Mains pressure

  • Mains size

  • Service entry type

  • Multiple occupancy building

  • Is it a dual service

  • Proposed method

  • Estimated job duration

  • Distance in public and material

  • Distance in private and material

  • Fire valve present

  • SCO required

  • Existing service material

Permit information

  • Permit required

  • Section 58 road

  • TM type

  • X and Y for excavation

  • Photograph of site

  • Planned Completion Date

Keyhole

  • Is main metallic?

  • Is main in carriageway ?

  • Are here known cables within 500mm of proposed excavation?

  • Is proposed excavation within 600mm away from existing tarmac patch?

  • If all four previous questions are answered yes, the task can be completed by Keyhole.<br>Can keyhole be used?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.