Title Page
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JANUS Reference
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Customer Account (Bill) Number
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Date/Time
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Location
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Surveyor/Installer Name
Survey
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Conduct survey?
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State details/reasons why survey abandoned
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Supporting evidence for abandoned survey
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Have you reviewed the generic risk assessment for this work type and completed a dynamic risk assessment if required?
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Please review the generic risk assessment for this work type and complete a dynamic risk assessment (DRA) if required. A DRA is always required if a meter installation is to be carried out
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Return visit/survey already completed?
Site details
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Contact Name
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Contact Number
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Property Type
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Use of sprinkler/unattended hosepipe
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Swimming Pool or Pond >10,000L
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Photo of Swimming Pool/Pond
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Number of Supplies
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Number of supplies to property (3+)
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Number of Points of Entry
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Number of Points of Entry (3+)
Supply details
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Riser Positions
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Pipe Material
- Black Poly
- Copper
- Iron
- Lead
- MDPE
- Other...
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Other...
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Pipe Size
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Other...
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Is Riser Stop Tap accessible?
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Is Riser Stop Tap operable?
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Isolates all fittings?
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Supply Type
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Shared with
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Branch stop tap?
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Is Main Stop Tap accessible?
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Is Main Stop Tap operable?
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Leakage detected?
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Is hot water supplied by a communal system?
Installation
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Existing meter?
Existing Meter Details
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Make and Model
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Serial Number
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Reading
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Location
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Can a meter be fitted under this scheme?
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Explain why a meter CANNOT be fitted under this scheme
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Supporting evidence
Installation
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Freezer kit required?
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Ladders required?
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Suggested installation location
Internal
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If an external meter cannot be fitted, state reasons why
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Suggested course of action
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Supporting evidence
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Return visit required by internal installation team?
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Sketch of existing external MST, pipework and proposed meter location
New Meter Details
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Tap "Add Meter" for each meter installed
Meter
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Make and Model
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Serial Number
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Label
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Meter Reading
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Location
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Location
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Diameter
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Cybil number
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Fitted in an unheated room/location
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Fitted by
Customer Declaration
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Customer NOT present
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I confirm that the meter has been installed to my satisfaction and I have witnessed the above reading(s)
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Leave feedback?
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Quality of Workmanship
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Time Keeping
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Cleanliness of site/appearance and attitude of operatives
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Customer comments
External
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Sketch of existing external MST, pipework and proposed meter installation
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Agreed date of installation
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Customer comments/feedback
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Customer to sign to confirm that they are responsible/authorised to approve the reinstatement on shared drives and footpaths
Comments
Additional information
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Additional comments
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Additional photos
