Header Sheet

  • Inspection Date :

  • Inspection By (Full Name) :

  • Document Number :

  • FSAM / FDA Code :

  • Inspection / Job I.D. :

  • Staff / Sub-Contractor Name :

  • Project Number (VPL use only) :

  • Field Manager Responsible :

  • Location

1. GENERAL / MANDATORY REQUIREMENTS

  • 1. OH&S Risks identified and addressed.<br>

  • 2. Environmental Risks Identified.

  • 3. Emergency contacts known.

  • 4. Dial Before You Dig (DYBD) Plans on site.

  • 5. Employees inducted & competent (VPL ID).

  • 6. Dedicated waste / disposal area allocated.

  • 7. Environmental controls have been forwarded to the field.

  • 8. Guards / Barriers / Signs positioned in correct locations.

  • 9. Traffic / Pedestrian Management in place.

  • 10. Traffic Management Plan completed.

  • 11. Temporary reinstatement completed.<br>

  • 12. Removal of Guards / Barriers / Signs.

  • 13. JSA & SWMS completed.<br>

  • 14. Practical Completion documents complete and accurate.

3. CIVIL WORKS

3.1 Pipe / Conduit Installation.

  • 1. Correct or approved alignment including route markers, achieved and installed to specifications and as per Construction Design.<br>

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 2. Correct or approved depth of conduit to achieved and to specifications.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 3. Correct or approved separation from existing services achieved.<br>

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 4. Correct conduit size and type installed.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 5. No more than two 90 degree sweeping bends installed within the run.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 6. Bedding and support of conduits achieved.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 7. Draw rope installed.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 8. Pipe/Conduit entry into pit, placement and sealing to specifications (min 50mm from bottom of pit).

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 9. Conduit Plugs installed in empty conduits, split plugs, TDUX installed where required.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 10. Where multiple conduits enter a pit, min 25mm separation is required between each conduit.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 11. Bore log maintained and available.

  • 12. Reducer / Joiner / Spigot / Pipe Bush installed, where required for pit entry.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 13. Pipe / Conduit attached to the pole as per specifications.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 14. Protective Guard fitted to the pole as per specifications.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

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  • 15. Site left safe.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 16. Reinstatement to the appropriate standards and rubbish removed.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 17. Warning signs fitted where required.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 18. Checked with "As Built" Data/Design (Pit location, item description captured correctly, GPS, etc.)

  • 19. Installation meets all other design documentation, specifications and approved variations.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 20. Breakout pipe sections are labelled.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 21. Marker Posts Installed where required.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

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  • 22. Correct marking displayed on marker post.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

3. CIVIL WORKS

3.2 Pits Installation (PIT).

  • 1. Correct materials used for pit foundation.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

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  • 2. Pit/Manhole installed conforms to slope and ground level.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

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  • 3. Correct depth, alignment and separation from other services.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

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  • 4. Correct size pit installed as per design.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

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  • 5. Pit Gasket fitted, where required (P Type Pits).

  • Defect Type :

  • Defect Location :

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  • Rectification Description :

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  • 6. Pit not in driveways or hazardous areas.

  • Defect Type :

  • Defect Location :

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  • Rectification Description :

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  • 7. Pit correct distance from roadways and corners.

  • Defect Type :

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  • Rectification Description :

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  • 8. Pit not contorted due to over compaction.

  • Defect Type :

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  • Rectification Description :

  • Rectify Defect By :

  • 9. Bedding, backfill and compaction to specifications.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

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  • 10. Centre bar, Cross bars and spacers fitted where required.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

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  • 11. Pipe entry and PVC bush positioned and fitted to standard.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 12. Through conduits aligned within the pit.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

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  • 13. Correct Pit Lid used with correct Brand with Weight Stamped.

  • Defect Type :

  • Defect Location :

  • Defect Description :

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  • Rectification Description :

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  • 14. Cuts and holes sealed with approved repair kit - hole saw guide utilised & hole diameter not excessive.

  • Defect Type :

  • Defect Location :

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  • Defect Photograph :

  • Rectification Description :

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  • 15. Pit raised as per specifications (risers sealed with plastic wrap/concrete) Screw spacing correct; correct type or angle of screws.

  • Defect Type :

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  • 16. Pit fitted over existing plant as per specification.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

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  • 17. Breakout pit entry sealed and labelled.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

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  • 18. Site left safe.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

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  • 19. Warnings signs fitted where required.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

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  • 20. Checked with "As Built" Data/Design (Pit location, item description captured correctly, GPS, etc.)

  • 21. Installation meets all other design documentation, specifications and approved variations.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 22. Joint enclosure mounting bracket and MPT mounting bracket installed to specification (Best work practice to bolt during pit install).

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

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  • 23. Reinstatement to the appropriate standards and rubbish removed.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 24. Pits installed in trafficable areas comply to load class B.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

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  • 25. Distances not exceeded between pits/manholes.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 26. Concrete surround fitted as per specifications.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 27. Collar rendered within concrete pits.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 28. Pipe entry and PVC Bush positioned and fitted to specification, min 50mm from bottom of pit, pipes/conduits flush with pit wall, no side entry to pits. (If side entry, defect is major).

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 29. Where multiple conduits enter a pit, 25 mm minimum separation is required between each conduit.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 30. Pipe/Conduit length within the pit/manhole as per specifications.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 31. Pipe/Conduit depth within the pit/manhole as per specifications.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 32. Size of pit suitable for connected conduits/cable size/device placement.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 33. Conduit that are road crossing or direction change conduits, are placed roadside in the trench and at pit entry.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

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  • 34. Cable Bearers fitted as per specification.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

3. CIVIL WORKS

3.3 FDH Plinth.

  • 1. Conforms to design location (local codes and permits).

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 2. Isolation gasket utilised (Front of cabinet alignment).

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 3. Cable entry conduit positioned correctly in pad, not impeding HSD and HSL cables, conduit installed 15 to 35mm above concrete slab.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 4. Cable entry conduit correct type/size (100mm).

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 5. Concrete plinth meets design specifications.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

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  • 17. Site left safe.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 18. Reinstatement to the appropriate standards and rubbish removed.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 19. Checked with "As Built" Data/Design (Pit location, item description captured correctly, GPS, etc.)

  • 22. Installation meets all other design documentation, specifications and approved variations.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 27. 50mm of compacted crushed rock installed prior to pouring of concrete base.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 28. Concrete plinth installed level and perpendicular.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 29. Anchor assembly kit installed.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 30. Min SL72 reinforcing mesh installed centrally within the concrete pad.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 31. FDH Plinth not located within an EPR zone.

  • Defect Type :

  • Defect Location :

  • Defect Description :

  • Defect Photograph :

  • Rectification Description :

  • Rectify Defect By :

  • 32. The concrete mix is 25mpa or better.

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.