Morton Bay Regional Council 1

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Complex Name

• Complex Address
  Address

• Assessment Date

  Date

Asset Identification and condition

• Asset Type

  Field lighting pole

  Pole mounted Distribution Board

  Carpark Pole Light

  Distribution Board

• Asset Identification

• Asset Condition

  1-Very Good, 90% expected remaining life

  2-Good, 70% expected life remaining

  3-Moderate, 50% expected remaining life

  4-Poor, 30% expected remaining life

  5-Very Poor, 10% expected remaining life

• Confidence Level

  A-Highly Reliable

  B-Reliable

  C-Uncertain

  D-Very Uncertain

  E-Not Assigned

• Estimated Remaining Life (Years)

• Are there any defects associated with this asset

• Photos of Asset

  Media

• Notes

Name and signature of Tradesman carrying out Audit

• Name

• Signature

  Sign