Title Page
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Prepared by
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Site Name (Facility ID / Name)
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Location/Address
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Work Order (if applicable)
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Conducted on
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Install Staff
Safety/Risk
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If Site Crew is onsite working; ensure JSEA/JHA and Permit to Work are being used
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are all risks being controlled as specified in JSEA/JHA
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Identify the level of traffic risk involved by accessing this chamber
- Very Low (Side Street/Garden Bed)
- Low (Footpath)
- Medium (Side Street Corner)
- High (Main Road)
- Very High (Main Road Intersection)
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Are you aware of the manual handling risks involved
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Is there a possible exposure to sharps
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Is there a sharps removal kit / disposal container accessible onsite
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Is chamber lid(s) / cabinet easily lifted without causing strain?
Audit Scope
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Inspection covers Full Install; Civil Install Only; IoT/Sensor/Comms Install Only
- Full Install (all)
- Civil Aspects Only
- IoT / Sensor / Comms Install Only
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Pole Install concreted in place / bolted adequately
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Conduits installed correctly; sealed; backfilled; draw wire; shielded above ground
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Include photo of Solar Panel serial # and make/model
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Solar panel fixed to top of pole and set to approx 33degrees
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Include Photo of IoT comms device, including serial # and make/model
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IoT comms installed neatly within cabinent (photo)
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Include photo of Pressure Sensor showing closeup of make/model and serial #
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Pressure Sensor is installed with no leaks visible; cable management/neat
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Aerial is installed neatly and connected to grounded structure
Communications (IoT)
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Is the communications being commissioned, or tested for connectivity?
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Is the pressure and battery readings feeding through to comms gateway?
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Is the pressure scaled correctly?
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Is the battery voltage scaled correctly?
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Are the internal settings correct<br>e.g Firmware, Clock, Battery
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Pole Install concreted in place / bolted adequately
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Conduits installed correctly; sealed; backfilled; draw wire; shielded above ground
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Solar panel fixed to top of pole and set to approx 33degrees
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Include Photo of solar panel serial # and make/model
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IoT comms installed neatly within cabinent (photo)
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Include Photo of IoT comms device, including serial # and make/model
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Pressure Sensor is installed with no leaks visible; cable management/neat
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Include photo showing closeup of make/model and serial #
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Aerial is installed neatly and connected to grounded structure
Communications (IoT)
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Is the communications being commissioned, or tested for connectivity?
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Is the pressure and battery readings feeding through to comms gateway?
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Is the pressure scaled correctly?
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Is the battery voltage scaled correctly?
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Are the internal settings correct<br>e.g Firmware, Clock, Battery
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Any other final comments / photos - INSERT HERE