Kembla Watertech Site Appraisal Form

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

SITE DETAILS

• Line/Asset Number:

• Pipe Material:

• Diameter:

• Length:

• U/S Manhole:

• D/S Manhole:

• Work Type

  Select Clean & CCTV EX Enviro Logi MH Grout Civils Patch Tiger T De-rooting

  • Clean & CCTV
  • EX
  • Enviro
  • Logi
  • MH Grout
  • Civils
  • Patch
  • Tiger T
  • De-rooting

UPSTREAM Maintenance Hole Location

• Remember to take photos of any useful information. On a regular question you can add media by tapping the question and then taking a photo. Also please remember to be as descriptive as possible.

• Has it been possible to gain access to the Manhole (if no, give reasons encountered)?

  Yes

  No

  N/A

• Is there access to the manhole location for the required equipment?

  Yes

  No

  N/A

• How far is the Manhole from the nearest vehicle parking location?

  Select 10m 20m 30m 40m 50m 60m 70m 80m 90m 100m 110m 120m 130m 140m 150m 160m 170m 180m 190m 200m 250m 300m 350m 400m 450m 500m 550m 600m 650m 700m More

  • 10m
  • 20m
  • 30m
  • 40m
  • 50m
  • 60m
  • 70m
  • 80m
  • 90m
  • 100m
  • 110m
  • 120m
  • 130m
  • 140m
  • 150m
  • 160m
  • 170m
  • 180m
  • 190m
  • 200m
  • 250m
  • 300m
  • 350m
  • 400m
  • 450m
  • 500m
  • 550m
  • 600m
  • 650m
  • 700m
  • More

• Is the Manhole visible?

  Yes

  No

  N/A

• Is the Manhole buried?

  Yes

  No

  N/A

• What level of Manhole opening equipment is needed?

  Basic lifter

  Gatic lifter (and hand tools)

  hydraulic lifter

• Was the Manhole opened for inspection?

  Yes

  No

  N/A

• Quantity of flow?

  Select 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

  • 0%
  • 10%
  • 20%
  • 30%
  • 40%
  • 50%
  • 60%
  • 70%
  • 80%
  • 90%
  • 100%

• Speed of flow?

  Still

  Slow

  Steady

  Fast

  Heavy

• Does the junction have any droppers?

  Yes

  No

  N/A

• Are there any access arrangements that need to be made before work can commence?

  Yes

  No

  N/A

• Has a notification letter been distributed?

  Yes

  No

  N/A

• Description of Location

• In the space provided mark the manhole position with an 'X'. Indicate any special hazards, gardens, trees, shrubbery, over head hazards and potential access issues

• U/S Location Diagram

  Drawing

• Add media

  Media

DOWNSTREAM Maintenance Hole Location

• Remember to take photos of any useful information. On a regular question you can add media by tapping the question and then taking a photo. Also please remember to be as descriptive as possible.

• Has it been possible to gain access to the Manhole (if no, give reasons encountered)?

  Yes

  No

  N/A

• Is there access to the manhole location for the required equipment?

  Yes

  No

  N/A

• How far is the Manhole from the nearest vehicle parking location?

  Select 10m 20m 30m 40m 50m 60m 70m 80m 90m 100m 110m 120m 130m 140m 150m 160m 170m 180m 190m 200m 250m 300m 350m 400m 450m 500m 550m 600m 650m 700m More

  • 10m
  • 20m
  • 30m
  • 40m
  • 50m
  • 60m
  • 70m
  • 80m
  • 90m
  • 100m
  • 110m
  • 120m
  • 130m
  • 140m
  • 150m
  • 160m
  • 170m
  • 180m
  • 190m
  • 200m
  • 250m
  • 300m
  • 350m
  • 400m
  • 450m
  • 500m
  • 550m
  • 600m
  • 650m
  • 700m
  • More

• Is the Manhole visible?

  Yes

  No

  N/A

• Is the Manhole buried?

  Yes

  No

  N/A

• What level of Manhole opening equipment is needed?

  Basic lifter

  Gatic lifter (and hand tools)

  hydraulic lifter

• Was the Manhole opened for inspection?

  Yes

  No

  N/A

• Quantity of flow?

  Select 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

  • 0%
  • 10%
  • 20%
  • 30%
  • 40%
  • 50%
  • 60%
  • 70%
  • 80%
  • 90%
  • 100%

• Speed of flow?

  Still

  Slow

  Steady

  Fast

  Heavy

• Does the junction have any droppers?

  Yes

  No

  N/A

• Are there any access arrangements that need to be made before work can commence?

  Yes

  No

  N/A

• Has a notification letter been distributed?

  Yes

  No

  N/A

• Description of Location

• In the space provided mark the manhole position with an 'X'. Indicate any special hazards, gardens, trees, shrubbery, over head hazards and potential access issues

• D/S Location Diagram

  Drawing

• Add media

  Media

COMMENTS

• Yes

  No

  N/A

• Site Appraisal conducted by:

  Sign

• Attendees:

  Sign