Job survey form

• Conducted on

  Date

• Prepared by

Customer information

• Address
  Address

• Customer name

• Customer telephone number

Job information

• Job description

• Mains material

  Spun Iron

  Cast iron

  PE

  Steel

  Asbestos

• Mains pressure

  LP

  MP

  IP

  HP

• Mains size

• Service entry type

  Select Surface mounted Semi con box HET Built in box Up and under Riser

  • Surface mounted
  • Semi con box
  • HET
  • Built in box
  • Up and under
  • Riser

• Multiple occupancy building

  Yes

  No

• Is it a dual service

  Yes

  No

• Proposed method

  Open cut

  Mole

  Live insert

  Dead insert

• Estimated job duration

• Distance in public and material

• Distance in private and material

• Fire valve present

  Yes

  No

• SCO required

  None

  RO

  NRO

• Existing service material

  PE

  Steel

  Serviflex

Permit information

• Permit required

  Yes

  No

• Section 58 road

  Yes

  No

• TM type

  Select None, signing only Some carriageway incursion Give and take 2 way lights 3 way lights 4 way lights Lane closure Road closure Footway closure Stop and go boards Priority working Convoy working

  • None, signing only
  • Some carriageway incursion
  • Give and take
  • 2 way lights
  • 3 way lights
  • 4 way lights
  • Lane closure
  • Road closure
  • Footway closure
  • Stop and go boards
  • Priority working
  • Convoy working

• X and Y for excavation

• Photograph of site

  Media

• Planned Completion Date

  Date

Keyhole

• Is main metallic?

  Yes

  No

• Is main in carriageway ?

  Yes

  No

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

  Yes

  No

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

  Yes

  No

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

  Yes

  No