Poor condition service, ECV and Poor Pressure Survey form

• Conducted on

  Date
• Address
  Address

• Engineers name

• Engineers telephone number

• Work order number

• Work order type

  poor pressure survey

  exchange ECV survey

  service relay condition survey

  service alteration non chargeable

Safety

• Site specific risk assessment carried out

  yes

  no

• Access gain to property

  yes

  no

• Internal gas surveyed around service entry

  yes

  no

  N/A

• Building line letter box checks carried out

  yes

  no

  N/A

• Leakage survey line of service carried out

  yes

  no

  N/A

Job specific engineering details

• Working and standing pressures tested

  yes

  no

  N/A

• Pressure recorded before governor, standing (in millibar)

• Pressure recorded before governor, working (in millibar)

• Follow on work identified

  Select relay service required part relay service required exchange ECV required issue rectified this visit no further work required No access

  • relay service required
  • part relay service required
  • exchange ECV required
  • issue rectified this visit
  • no further work required
  • No access

• Is access required

  yes

  no

• Material of service

  PE

  Steel

  Lead

  Copper

• Is service dualled

  yes

  no

• If yes, specify number dualled with

• Will any works be required in the public

  yes

  no

• Is traffic management required

  yes

  no

• If yes please specify

  Select pedestrian walkway in road carriageway incursion two way traffic maintained two way traffic lights required three way traffic lights required four way traffic lights required bus/cycle lane suspension required above 30mph speed limit

  • pedestrian walkway in road
  • carriageway incursion two way traffic maintained
  • two way traffic lights required
  • three way traffic lights required
  • four way traffic lights required
  • bus/cycle lane suspension required
  • above 30mph speed limit

• Engineering difficulties on site

  yes

  no

• If yes please specify

  Select unable to park vehicle location is on a blind bend existing service is 3/4" steel up and under service existing service is located in open cavity existing service built over meter box required imprinted concrete driveway landscaped garden rendered building lead/ copper service pipe long drill and long house entry

  • unable to park vehicle
  • location is on a blind bend
  • existing service is 3/4" steel
  • up and under service
  • existing service is located in open cavity
  • existing service built over
  • meter box required
  • imprinted concrete driveway
  • landscaped garden
  • rendered building
  • lead/ copper service pipe
  • long drill and long house entry

• Any other difficulties please specify

• Does service cross the road

  yes

  no

  N/A

• Estimated job duration for repair (in hours)

• Internal alter position required

  yes

  no

  N/A

• length internal pipe run (in meters)

• Is 28mm pipe required

  yes

  no

• If yes specify amount needed in meters

• Estimated job duration for alter position in hours

Customer details

• Customer name

• Customer's preferred contact number

• Customers email address

• Resource management to plan

  yes

  no

• Customer's preferred plan date (minimum 2 weeks notice needed)

  Date

• Has this been confirmed with resource management

  yes

  no

• Has new meter location been agreed

  yes

  no

• If yes please specify agreed location

• If dual service identified, contact details for second customer

• Name

• Contact number

• Email address

• Photos

  Media