• Workorder No.

  • Audit Title

  • Conducted on

  • Prepared by

  • Location
  • Work to be done description

Repair details

  • Urgency of repair

  • Work to be completed description

  • Suggested repair Date/time

Assessment details

  • Locations complete

  • Shutoff required?

  • School in shutoff block?

  • Business in shutoff block?

  • Hospital in shutoff block?

  • Residential in shutoff block?

  • Number of valves in shutoff?

  • Additional resources required for shutoff?

  • Notification cards required?

  • Number of cards required?

  • Traffic control required?

  • Traffic control special details

  • Fittings required for repair?

  • Can be completed by 2 man team?

  • Can this be completed with 5.5t excavator?

  • Can site be accessed be excavator trailer?

  • Welder required to perform on-site work?

  • Special requirements or instructions? Eg: shoring, hydro escalation, cold/hot mix

  • Add photo

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.