Pre-Planning Prompts

• Workorder No.

• Audit Title

• Conducted on

  Date

• Prepared by

• Location
  Address

• Work to be done description

Repair details

• Urgency of repair

  1 Day

  2 Days

  3 Days

  1 Week

  2 Weeks

• Work to be completed description

• Suggested repair Date/time

  Date

Assessment details

• Locations complete

  Yes

  No

  Incomplete

• Shutoff required?

  Yes

  No

• 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?

  Yes

  No

• Number of cards required?

• Traffic control required?

  Yes

  No

• Traffic control special details

• Fittings required for repair?

• Can be completed by 2 man team?

  Yes

  No

• Can this be completed with 5.5t excavator?

  Yes

  No

• Can site be accessed be excavator trailer?

  Yes

  No

• Welder required to perform on-site work?

  Yes

  No

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

• Add photo

  Media

• Draw a sketch here

  Drawing