Title Page

  • JANUS Reference

  • Customer Account (Bill) Number

  • Date/Time

  • Location
  • Surveyor/Installer Name


  • Conduct survey?

  • State details/reasons why survey abandoned

  • Supporting evidence for abandoned survey

  • Have you reviewed the generic risk assessment for this work type and completed a dynamic risk assessment if required?

  • 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

  • Return visit/survey already completed?

Site details

  • Contact Name

  • Contact Number

  • Property Type

  • Use of sprinkler/unattended hosepipe

  • Swimming Pool or Pond >10,000L

  • Photo of Swimming Pool/Pond

  • Number of Supplies

  • Number of supplies to property (3+)

  • Number of Points of Entry

  • Number of Points of Entry (3+)

Supply details

  • Riser Positions

  • Pipe Material

  • Other...

  • Pipe Size

  • Other...

  • Is Riser Stop Tap accessible?

  • Is Riser Stop Tap operable?

  • Isolates all fittings?

  • Supply Type

  • Shared with

  • Branch stop tap?

  • Is Main Stop Tap accessible?

  • Is Main Stop Tap operable?

  • Leakage detected?

  • Is hot water supplied by a communal system?


  • Existing meter?

Existing Meter Details

  • Make and Model

  • Serial Number

  • Reading

  • Location

  • Can a meter be fitted under this scheme?

  • Explain why a meter CANNOT be fitted under this scheme

  • Supporting evidence


  • Freezer kit required?

  • Ladders required?

  • Suggested installation location


  • If an external meter cannot be fitted, state reasons why

  • Suggested course of action

  • Supporting evidence

  • Return visit required by internal installation team?

  • Sketch of existing external MST, pipework and proposed meter location

New Meter Details

  • Tap "Add Meter" for each meter installed

  • Meter
  • Make and Model

  • Serial Number

  • Label

  • Meter Reading

  • Location

  • Location

  • Diameter

  • Cybil number

  • Fitted in an unheated room/location

  • Fitted by

Customer Declaration

  • Customer NOT present

  • I confirm that the meter has been installed to my satisfaction and I have witnessed the above reading(s)

  • Leave feedback?

  • Quality of Workmanship

  • Time Keeping

  • Cleanliness of site/appearance and attitude of operatives

  • Customer comments


  • Sketch of existing external MST, pipework and proposed meter installation

  • Agreed date of installation

  • Customer comments/feedback

  • Customer to sign to confirm that they are responsible/authorised to approve the reinstatement on shared drives and footpaths


Additional information

  • Additional comments

  • Additional photos

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.