Work order number.

Full Address Details

Customer Contact Details

General Comment box

Work order type

Have you gained access?

Date and Time of Survey.
Fit Type.

Can a meter be installed internally

Unmeterable internal reason
Photo ISV

How many bedrooms

How many occupants

Proposed First Option of Fit
Proposed Second Option of Fit
O/S/V Details.


Photo consent form

O/S/V Depth?

O/S/V Location

Photo of O/S/V location
Street view photo
Surface Material Type

Traffic Management comments

Customer & Surveyor Name and Signature
Customer Signature & Name. To confirm Surveyor visit
Surveyor Signature & Name
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.