Title Page
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Site conducted
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Environment Agency Area
- YORKSHIRE
- CUMBRIA AND LANCASHIRE
- GREATER MANCHESTER
- MIDLANDS SWWM
- MIDLANDS SHWG
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Watercourse ID
Site Location
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Add location
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Conducted on
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Prepared by
Culvert Inlet
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Inlet Location - GPS
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Traffic Management
- No
- Yes
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Landowner
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Site Information (Including contact details)
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Culvert Height mm
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Culvert Width mm
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Water Level mm
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Silt Depth mm
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Speed of flow recorded at time of survey
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Material
- Masonry
- Concrete
- Brick
- Steel
- Plastic
- Other
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Asset Photos
Culvert Outlet
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Outlet Location - GPS
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Traffic Management
- No
- Yes
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Landowner
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Site Information (Including contact details)
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Culvert Height mm
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Culvert Width mm
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Water Level mm
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Silt Depth mm
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Speed of flow recorded at time of survey
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Material
- Masonry
- Concrete
- Brick
- Steel
- Plastic
- Other
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Asset Photos
Additional Assets
- Additional Assets
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Asset Type
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Location - GPS
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Photos of Manhole
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Traffic Management
- No
- Yes
Additional photos
Additional photos - photos can be loaded in groups. It's is easier to add how many groups you would like to add first.
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Add photos
Photo Group
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Add media
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Work Details
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Nature of works
- Remote CCTV
- Confined Space Man Entry Assist CCTV
- Confined Space Man Entry Assist CCTV (Structural Survey)
- Confined Space Manual Man Entry Survey
- Culvert Cleaning utilising HPWJ
- Culvert Cleaning utilising mechanical plant
- Pre Survey Only
- Other
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Culvert Confined Space Classification
- NC1
- NC2
- NC3
- NC4
Risk Rating - Low, Medium, High.
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Risk Classification of the Confined Space.
- None
- Low
- Medium
- High
Man Entry Requirements
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Do we need to enter the Confined Space
- No
- Yes
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Number of men for task
- 2
- 3
- 5
- 6
- 7
- 3 man rescue team
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Culvert Length
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Silt sample required
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CCTV Additional Requirements/info
- Full Condition Survey
- Fast Pass CCTV Survey
- GPS of Assets
- Manhole Cards
- CaD Drawing
Additional Equipment
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Additional Equipment Required
- Proteus Portable CCTV Equipment
- Counter Balance Davit Arm
- 4" - 6" Pumps
- Mitigation
- Stanks - Stop Logs
- Aquadam
- Portadam
- 360 Excavator
- Dumper
T98 Condition Grade (Visual Inspection)
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Condition grade of the culvert
Summary of findings
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Work recommendations to client
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Planning / Risk Control
Control of Risk
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If there are any aspects of the work which is not covered by RAM Utility Solutions generic RAMs then additional information and planning to control the risk is required. This is achieved by answering the relevant section below to identify the specific additional risks to cover.
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Overhead Services
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Information on services
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Photos of Overhead services
Pollution & Environmental Control
Environmental & pollution control
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Record any habitat and bio diversity issues identified (aquatic, plants, animals, sensitive or endangered flora & fauna)
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Will the works impact downstream?
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Detail what measures need to be taken to control this
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Is there any risk to fish?
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Detail the controls will be in place
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Is there a pollution risk?
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Detail the controls in place
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Pollution risk
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Is the flow of the watercourse likely to change during the duration of the works?
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Sign Off
Report Complete
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Signature