1. Site Visit
1.1. Pre Visit Details
Mains Type
Plan of Subdivision
MEA. (Maximo Expenditure Approval)
1.2. Site
Location Plan
Plan with marked up locations eg tie-ins, crossings, special items
Bill board photo
Approximate Gas requirement date
1.3. Conditions

Enter Stage of Works

Stage of Works

JSA Number

Stage of Development
Conducted on
Photo of site conditions

Are Soil Conditions known

Soil Details Desription

Add media

Information on soil conditions

no label
1.4. Tie in details

Tie in details

Add media
Add drawing

Details if required

1.5. Contacts

Contact Details




Phone / Email

Water Contractor

Contractors Name and details

Is contractor Gas qualified

1.6. Crossing Details

Are any Special Crossings required eg Drain, Railway, Bridge

Crossing Details

Crossing Type

Crossing Type

Crossing Details

Add media
1.7. Misc Details

Property Line Definition

Property Line Details

Add media


Add media

Easement Details

Date design requested

Flora Details eg trees, plants, grasses

Add media

Flora Details

Date design requested

Fauna Details eg Birds, animals, reptiles

Add media

Fauna Details

Native Settlement Investigation

Add media

Native Settlement Details

Contaminated Soils

Contacted soil details are required. Need to contact ....?... For additional details

Add media

Contaminated Soil Details


Add media

Miscellaneous Details

Date design requested
1.8. Special Considerations




2.0 Provings

Are any Provings required

Proving details


Proving Details

Add media
3.0 Other Utilities

Have other utilities been picked up


Location Details

Add media
3. Misc

Special approvals eg Vic Roads, GasNet

Approval required from

Enter details

Special warnings eg Transmission Pipeline

Marker Post Details

DBYD required


Auditors signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.