Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Client / Site

  • Region

  • Contractor/s

  • Job Description

  • Date

  • Time

1. Reinstatement

  • Is the temporary reinstatement free from trip hazards and left in a satisfactory manner?

  • Has all task related waste been removed from site?

  • Have grassed areas been top soiled and seeded and are free of debris?

  • Have garden beds been reinstated satisfactorily. Plants replaced, mulch and toppings free from clay or other materials?

  • Does permanent reinstatement and compaction meet Vic roads, Local Council, property owner’s requirements?

  • Have concrete saw over cuts been kept to a minimum?

  • Have concrete saw over cuts been removed as part of the hard surface reinstatement?

  • Where site is to be left overnight, are adequate protection measures, lighting and night guidance provided?

  • Has Refix / Relight been completed?

  • If required, was a red card left with correct information and details?

  • Has a clean up notice been left with the consumer?

2. MG Standards

  • Have MG standards (meter locations, clearances, etc.) been maintained?

  • Does pipe coating meet MG standards?

  • Does construction meet MG requirements?

  • Have other authority’s assets been identified and proved?

  • If required, has meter protection been installed?

  • Has fitting line been installed in accordance with AS 5601?

  • Has regulator vent been installed and installed correctly?

  • Has slab and enclosure been installed?

  • Does the slab and enclosure meet MG standards?

  • Is tracer wire in place at up stands?

  • Is Manifold/Up stand supported as per MG requirements?

  • Have all marker posts been installed as per MG requirements?

  • Have valve syphon test point etc covers been installed as per MG requirements?

  • Is there evidence of a satisfactory area covered for leakage location and identification?

  • Has a line valve been installed as per MG requirements?

  • Has the abandoned service up stand been removed/cut from above ground?

  • Is the daily location sheet accurate?

3. House Keepiing

  • Crushed rock laid level and compacted.

  • Evidence of subsidence in compound and entry and exits.

  • Evidence of debris/rubbish.

  • Interior of compound clear of fire hazards, tidy.

  • Exterior of compound clear of fire hazards, tidy?

  • Fire Protection e.g. Fire Extinguishers, etc. in place and in test date.

  • Security of compound fence, gates etc.

  • Paint work on buildings, posts and bollards etc.

  • Warning signs, Emergency Contact details legible in place and with current information?

  • PPE signs/notification?

  • Comments

  • Overall Audit Rating

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.