Information

  • FIR Reference Number

  • Radlink Audit Number

  • Conducted on

  • Prepared by

  • Location
  • Kordia Map Number

Survey Data

Survey Data collection

  • Select Survey Type

  • Duct Number

  • FIR Status

  • Duct Location

  • Actual Duct Size (if different)

  • Was the Duct Roped

  • Was the Duct Roped

  • Actual Measured Length (m) (Roped Length)

  • Maximum Mandrel Head Size (mm)

  • Duct Solution

  • Construction Method

  • A end blocked distance (m)

  • B end blocked distance (m)

  • Surface Type

  • Mandrel Type

  • General Comments

  • Enter reason not inspected

  • Duct Location

  • Actual Duct Size (if different)

  • Was the Duct Roped

  • Actual Measured Length (m) (Roped Length)

  • Maximum Mandrel Head Size (mm)

  • General Comments

  • FIR Pit Referance Number

  • FIR Status

  • Pit Location

  • Actual Pit Size (if different)

  • Damage Requiring Repair

  • Reason for device relocation

  • Remediation Required

  • Reason for Remidiation

  • Surface Type

  • General Comments

  • Enter reason not inspected

  • General Comments

Photo's

  • Photo's of Pit or Duct

  • Take Photo of the Duct A end in the Pit

  • Take Photo of the Rope Tag at Duct A end

  • Take Photo of the Duct B end in the Pit

  • Take Photo of the Rope Tag at Duct B end

  • Take Photo looking along the duct if roping not successful ( From A and B end )

  • Take Photo the Pit from the road verge

  • Take Photo inside of Pit

  • Take Photo of conduit entry on Left hand-side (Manholes only) (Pit - only need separate photo if ducts not clear inside pit photo)

  • Take Photo of conduit entry on Right hand-side (Manholes only) (Pit - only need separate photo if ducts not clear inside pit photo)

Help

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.