Cover sheet
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End Client
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Customer Reference
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Project Name
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Quotation/Optiline/Estimate number
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A55 Number(s) - If applicable/Known
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PIANOI Number If applicable/Known
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Site Address
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Date job was started
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Date job was finished
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Gang leader Name
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Document dated
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Signed
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Attach Map with locations of synthetics (If applicable)
Blockages
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Click Add Blockage (+) to upload blockage details.
Blockage
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Duct section number
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Blockage number
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12 digit Co-ordinates of blockage - Easting & Northing
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Blockage type
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Permit reference
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Reinstatement dimensions Length and Width (m)
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Site setup/Location photos SLG
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Photos of surface before excavation
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Photos of Damage/Blockage Repair Requirement
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Photos of repair kit - Duct must be visible either side of repair kit and 3 x cable ties used and cut flush
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Was the job cabled live?
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Photo of back rope and or cable pulled through in each chamber
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Completion photos - Reinstatement and site left clean and safe images
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Is a return visit required to complete permanent reinstatement?
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Please state any other relevant information with photo evidence – If applicable
New Track
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Click Add New Track (+) to upload New Track details.
New Track
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Total length of new track section (m)
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Permit reference(s)
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12 digit Start location Co-ordinates of - Easting & Northing
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12 digit end location Co-ordinates of - Easting & Northing
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Start chamber/Structure type
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End chamber/Structure type
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Total length and width of duct trench (m)
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How many new duct bores have been laid in the trench
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Length of duct in verge (m)
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Length of duct in FW (m)
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Length of duct in CW (m)
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SLG Site setup/Location photos and surface condition before excavating
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During Photos of new track laying in the open trench including tape measure to show duct has been laid at the correct depth
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Completion photos – Ground reinstated
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Photos of duct entrees completed to spec in chamber/structure at each end of duct length - including use of G
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Is a return visit required to complete permanent reinstatement
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Please state any other relevant information with photo evidence – If applicable
New Chamber
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Click Add New Chamber (+) to upload New Chamber details.
New Chamber
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Chamber type
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Permit Reference
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12 Digit Location Co-ordinates of - Easting & Northing:
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Pre-Excavation Condition: Photos showing the ground and surrounding area before any excavation began and SLG site setup
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Excavation Depth and Dimensions: Photos showing the dimensions and depth of the excavated hole before installing the chamber base.
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Drainage or Gravel Layer: Show evidence of any drainage layer (like gravel or sand) at the bottom of the excavation to ensure water management.
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Chamber completion (without cover on) showing: Soak away in base of chamber, duct entrances and sealing, chamber location.
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Chamber completion cover on showing: Chamber label, chamber location.
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Please state any other relevant information with photo evidence – If applicable
