Information

  • Site conducted

  • Prepared by

  • Job Number

  • Site Address

  • Works Description

  • Date of Visit

  • Team Leader / Mates

Qualifications .1

  • Gas Qualification Team Leader (level 1, Level 2 etc.)

  • Gas Qualification Team Mate (level 1, Level 2 etc.)

  • Gas Network Safety Passport (All Team Members)

  • Gas Safe Registration Card

  • NRSWA Operators Card Onsite

Documentation .2

  • Site Specific Risk Assessment in Use, Signed and Dated

  • Contract Job Pack on Site

  • Existing Utilities Plans on Site and in Use

  • Are the As-Laid Drawings Being Completed and up to Date

Health and Safety Elements .3

  • Working Site Clean and Tidy

  • PPE Available for Activities Undertaken

  • Eyewash bottles are in date

Signing Lighting and Guarding .4

  • Copy of The NRSWA Red Book available

  • Is Chapter 8 Setup as Red Book Requirements

  • Is Vehicle Traffic Being Controlled

  • Is Pedestrian Traffic Being Controlled

  • Courtesy Boards in Use

  • Permit Board Out and in Use

  • Access and Egress to Properties Acceptable

  • Footpath Boards in Use and Secure

  • Road Plates in Use and Secure

Excavation .5

  • Are the Excavations as per the Route on the Design Plan

  • Excavation is Shored Correctly (If Applicable)

  • Trench Widths & Depths Are Acceptable for The Pipe Installation

  • If Depths of cover are not achieved has a variation been approved by the Technical Advisor (In notes record variation and photograph evidence)

  • Siting of Plant and Materials Near Excavations

Pipe Handling & Installation .6

  • Gas Pipe Being Stored/Staked Correctly

  • Fitting are All Bagged Until Use

  • Plant Clearances acceptable

  • Has Electrofusion Been Witnessed

  • Are Scrapers Being Used

  • Top Tee Clamp -1 Onsite and in Calibration

  • Top Tee Clamp - 2 Onsite and in Calibration

  • Joint Alignment Clamps in Use

  • Has the Joint been Completed Correctly (e.g. Signs of etching, coupler marked and Installers Information on the Pipe)

  • End Caps Available and in Use

  • Weather Protection in Inclement Weather in Use (Pipe Protection)

  • Bead Gauge (Butt Fusion Process) In Use

  • Have the Appropriate Photos Been Submitted for the Activities Onsite

Testing .7

  • Has the Test area Been Adequately Barriered off to Prevent Inadvertent Access

  • Is the Test area Adequate to Allow the Monitoring of the Test Gauge without Entering the Excavation

  • Is a Water Gauge Being use and is it Filled Correctly

  • Mains on Test Sign Out and in Use

  • Test Standpipe in Calibration

  • LP Test Equipment (Comark) in calibration

  • MP Test Equipment (Druck ONLY) in calibration

  • Is Permit to Work on site for MP test

  • Is the Testing Criteria Available and Understood by the Team

  • Testing Hand Pump or Small Compressor in Use

  • Compressor (For Testing) Onsite (Owned By, Plant Number, and Service Date Required)

  • Is the Test Certification Onsite and being Completed during test

Connections .8

  • Fire Extinguisher 1 Out Ready for Use and Fully Charged

  • Fire Extinguisher 2 Out Ready for Use and Fully Charged

  • BA 1 Available. Inspected and Ready for Use

  • BA 2 Available. Inspected and Ready for Use

  • NRO/ROU/PTW Onsite and Being Complied With

  • Is Flame Retardant Clothing Being Worn

  • Bypass Position Being Managed Safely

  • Gascoseeker in Use and In Calibration

  • Squeeze-Off Equipment in working condition and spare on site

  • Vent Pipe/Stack in Use

  • Purge Hose in Use

  • Leak Detection Fluid in Use

  • Re-Rounding Clamps Available

  • Squeeze-Off Tape applied

Meter Installation Works .9

  • Location of Meter Box is Acceptable

  • Meter Box Integrity and Secured in Place

  • MPRN label Attached and photographed

  • MP label attached

  • Internal meter location is ventilation acceptable

  • MOB Pre-Commissioning Check List Completed

  • MOB A3 Composite Label Sited Correctly

Backfilling .10

  • Sand Bed and Pipe Surround Acceptable

  • Marker Tape in Use and Acceptable

  • Backfilling Material Acceptable

  • Compaction to HAUC Acceptable

  • Correct base and wearing course materials

Items for Calibration / Maintenance .11

  • Electrofusion box

  • Generator

  • C.A.T Available

  • GENNY Available

  • Butt-fusion Box

  • Extension leads Pack Tested

  • Lifting Equipment - 1 In Date

  • Lifting Equipment - 2 In Date

Record of Corrective Actions (Below) .12

  • Comments

  • Photographs

Signatures .13

  • Team Leader Signature

  • Auditor Signature

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.