Title Page

  • GW Reference No:

  • Location

  • Conducted on

  • Location
  • Personnel

Sewer

  • Is Sewer to be audited?

  • MH
  • Structure name

  • Cover level with surrounding FSL

  • Cover is accessible

  • Other

  • Photos

  • MS/TMS
  • Structure name

  • Cover level with surrounding FSL (hasn't dropped onto the riser)

  • Cover is accessible

  • Shroud central and not damaged

  • Other

  • Photos

  • Trenches &/or subsidence
  • Trenches filled & level

  • Other

  • Photos

Water

  • Is water to be audited?

  • Fire Plugs

  • Fire plug
  • Location

  • Cover level with surrounding FSL & central

  • Fire plug central

  • Marker post installed

  • Road reflector installed

  • Other

  • Photos

  • Stop Valves

  • SV
  • Location

  • Cover level with surrounding FSL & centred

  • Spindle central

  • Shroud central & not damaged

  • Marker post (if required)

  • Photos

  • Other

  • Trenches &/or Subsidence

  • Trenches &/or subsidence
  • Trenches filled & level

  • Other

  • Photos

  • Washout Box

  • Washout box
  • Location

  • Box level with FSL

  • Ferrule accessible

  • Other

  • Photos

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.