Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Customer / Job Details

  • Name

  • Address

  • Contact

  • SO Number

  • Commit Date

Health, Safety and Environmental Issues

  • Underfloor access?

  • Ceiling access?

  • ETP present?

  • Pipe direct into house?

  • Digging in road reserve required?

  • Gas detector required?

  • Car parked over manhole?

  • Dogs on site?

  • Obstructions to network / premise

  • Number of pits / manholes between FAT and premise?

Consents Required

  • Right of way?

  • Multi dwelling unit?

  • Protected trees (Arborist required)?

  • Heritage land?

  • Heritage buildings?

Network

  • Fibre type?

  • Network type?

  • 50mm drop off correctly installed?

  • Water in chambers?

  • Tapes in place?

  • Tapes moving?

  • Tapes connected to correct FAT?

  • FAT location?

  • Length of haul / blow?

  • Distance from FAT to ETP?

Civil Required

  • Hand dig?

  • Drill?

  • Water?

  • Grundomat?

Reinstatement Required

  • Grass?

  • Seal?

  • Concrete?

Additional notes

  • Notes

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.