Information
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Document No.
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Inspection category ( drainage, Bus Shelter eg.)
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Address of hazard
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Conducted on Month/ Date/Year
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Prepared by
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Location
Defect
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Is there a defect
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Type of defect ( blocked, broken, damaged eg)
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Add media
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Action required
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Type of action required ( clear, repair replace eg)
Rating score of defect
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High Medium Low
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Work Instruction
Completion details
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Action taken
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Works completed by
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Date of Works Completed.