R&KGROUP R&M

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

INITIAL INSPECTION

• JOB PRIORITY

  Select Priority 1 Priority 2 Priority 3 Priority 4 Priority 5 Priority 6 Priority 7 Priority 8 Priority 9 Priority A

  • Priority 1
  • Priority 2
  • Priority 3
  • Priority 4
  • Priority 5
  • Priority 6
  • Priority 7
  • Priority 8
  • Priority 9
  • Priority A

• Original ST Order Number

• DLO/CONTRACTOR

• New FOW Order Number

JOB ADDRESS/LOCATION DETAILS

• Occupier's Name/Telephone Number

• Property Name/Number

• Street/Road Name

• Town/City

• Postcode

• PTD Signed

  YES

  N/A

  LEFT WITH CUSTOMER

FOW Works Address/Location Details

• Occupiers Name/Telephone No.

• Property Name/Number

• Street Name/Number

• Town/City

• Postcode

• 12 Figure Grid Reference (Of Defect)

• Location of FOW

  Public Highway

  Private Land

  Restricted Land

PROPOSED WORK DETAILS (inc TM)

• Manhole Number

• Manhole cover size

• Is STW Asset

  YES

  NO

• Start Manhole

• Finish Manhole

• Manhole Chamber Size

COMMENTS/DESCRIPTION OF JOB (Inc Photos)

• Add media

  Media

• Transferred Asset

  YES

  NO

• Section 81 Manhole

  YES

  NO

• Type of Cover

  IC

  Manhole

• Any Hand Dig Required

  YES

  NO

• Road Width

• Road Markings

• Position of follow on works

  carriageway

  Verge

  Footpath Bridleway

  Footpath next to road

  Private

• Surface type

  Select HRA 6mm SMA 10mm SMA 14mm SMA 6mm BITMAC 10mm BITMAC GRASS UNMADE GROUND CONCRETE SLABS BLOCKS/PAVING

  • HRA
  • 6mm SMA
  • 10mm SMA
  • 14mm SMA
  • 6mm BITMAC
  • 10mm BITMAC
  • GRASS
  • UNMADE GROUND
  • CONCRETE
  • SLABS
  • BLOCKS/PAVING

• Road Markings

• Specialist Treatment

• Any Existing Traffic Control Within 50m of The Works

• Road Width

• Speed Limit

• Are There Any Cars Parked at The Time of The Inspection

  YES

  NO

• Could There Be cars Parked on Other Days or at Different Times?

  YES

  NO

• When?

• What Traffic Management Is Required?

• Is There a Bus stop Within 50m of The Work? (Mark on plan and supply bus stop number and operator)

• Distance from Kerb to Excavation/Manhole

• Parking Suspension

HEALTH AND SAFETY INFORMATION

• Overhead Power Lines within 10m

  YES

  NO

• Lamp Support Required or Removal

  YES

  NO

• Details

• Confined Space Working

  YES

  NO

• Details

• Other Safety Information

• Customer Special Requirements (including preferred day or time and any special needs)

FOLLOW ON WORKS - MANHOLES

INITIAL INSPECTION

• Date of inspection and time on site

  Date

• Time off site

  Date

• JOB PRIORITY

  Select Priority 1 Priority 2 Priority 3 Priority 4 Priority 5 Priority 6 Priority 7 Priority 8 Priority 9 Priority A

  • Priority 1
  • Priority 2
  • Priority 3
  • Priority 4
  • Priority 5
  • Priority 6
  • Priority 7
  • Priority 8
  • Priority 9
  • Priority A

• Original ST Order Number

• DLO/CONTRACTOR

• New FOW Order Number

JOB ADDRESS/LOCATION DETAILS

• Occupier's Name/Telephone Number

• Property Name/Number

• Street/Road Name

• Town/City

• Postcode

FOW Works Address/Location Details

• Occupiers Name/Telephone No.

• Property Name/Number

• Street Name/Number

• Town/City

• Postcode

• PTD Signed

  Select YES N/A LEFT WITH CUSTOMER

  • YES
  • N/A
  • LEFT WITH CUSTOMER

• 12 Figure Grid Reference (Of Defect)

• Location of FOW

  Public Highway

  Private Land

  Restricted Land

PROPOSED WORK DETAILS (inc TM)

• Manhole Number

• Manhole cover size

• Manhole Type

  Surface

  Foul

  Combined

• Is STW Asset

  YES

  NO

COMMENTS/DESCRIPTION OF JOB (Inc Photos)

• Add media

  Media

• Transferred Asset

  YES

  NO

• Section 81 Manhole

  YES

  NO

• Any Hand Dig Required

  YES

  NO

• Type of Cover

  IC

  Manhole

• Has the asset been traced and marked

  YES

  NO

• Position of follow on works

  Select carriageway Verge Footpath Bridleway Footpath next to road Private

  • carriageway
  • Verge
  • Footpath Bridleway
  • Footpath next to road
  • Private

• Surface type

  Select HRA 6mm SMA 10mm SMA 14mm SMA 6mm BITMAC 10mm BITMAC GRASS UNMADE GROUND CONCRETE SLABS BLOCKS/PAVING

  • HRA
  • 6mm SMA
  • 10mm SMA
  • 14mm SMA
  • 6mm BITMAC
  • 10mm BITMAC
  • GRASS
  • UNMADE GROUND
  • CONCRETE
  • SLABS
  • BLOCKS/PAVING

• Road Markings

• Specialist Treatment

• Any Existing Traffic Control Within 50m of The Works

• Road Width

• Speed Limit

• Are There Any Cars Parked at The Time of The Inspection

  YES

  NO

• Could There Be cars Parked on Other Days or at Different Times?

  YES

  NO

• When?

• What Traffic Management Is Required?

• Is There a Bus stop Within 50m of The Work? (Mark on plan and supply bus stop number and operator)

• Distance from Kerb to Manhole

• Parking Suspension

• Any other information

HEALTH AND SAFETY INFORMATION

• Overhead Power Lines within 10m

  YES

  NO

• Lamp Support Required or Removal

  YES

  NO

• Details

• Confined Space Working

  YES

  NO

• Details

• Other Safety Information

• Customer Special Requirements (including preferred day or time and any special needs)

FOLLOW ON WORKS - DIG DOWNS

INITIAL INSPECTION

• JOB PRIORITY

  Select Priority 1 Priority 2 Priority 3 Priority 4 Priority 5 Priority 6 Priority 7 Priority 8 Priority 9 Priority A

  • Priority 1
  • Priority 2
  • Priority 3
  • Priority 4
  • Priority 5
  • Priority 6
  • Priority 7
  • Priority 8
  • Priority 9
  • Priority A

• Original ST Order Number

• DLO/CONTRACTOR

• New FOW Order Number

JOB ADDRESS/LOCATION DETAILS

• Occupier's Name/Telephone Number

• Property Name/Number

• Street/Road Name

• Town/City

• Postcode

• PTD Signed?

  Select YES N/A LEFT WITH CUSTOMER

  • YES
  • N/A
  • LEFT WITH CUSTOMER

FOW Works Address/Location Details

• Occupiers Name/Telephone No.

• Property Name/Number

• Street Name/Number

• Town/City

• Postcode

• 12 Figure Grid Reference (Of Defect)

• Location of FOW

  Public Highway

  Private Land

  Restricted Land

• Is CCTV Done

  YES

  NO

• Is Evidence Rcorded

  YES

  NO

• Has The Line Been Rodded or Jetted

  RODDED

  JETTED

• What Was The Cause?

• Percentage of Cause

PROPOSED WORK DETAIL FOR FOW(Inc TM)

• ASSET

  Select GRAVITY SEWER RISING MAIN MANHOLE CONSTRUCTION MANHOLE COVER AND FRAME INTERCEPTOR FLAT VALVE NRV SSIP WORKS CSO ANCILLARY NONE

  • GRAVITY SEWER
  • RISING MAIN
  • MANHOLE CONSTRUCTION
  • MANHOLE COVER AND FRAME
  • INTERCEPTOR
  • FLAT VALVE
  • NRV
  • SSIP WORKS
  • CSO
  • ANCILLARY
  • NONE

• TASK

  Select 2ND LINE BLOCKAGE FLOODING CCTV FLOODING CLEANSE REACTIVE CCTV REACTIVE CLEANSE REACTIVE ROOT CUT RELINE REINSTATE REPAIR RESET RENEW REMOVE REBENCH CLEAN UP

  • 2ND LINE BLOCKAGE
  • FLOODING CCTV
  • FLOODING CLEANSE
  • REACTIVE CCTV
  • REACTIVE CLEANSE
  • REACTIVE ROOT CUT
  • RELINE
  • REINSTATE
  • REPAIR
  • RESET
  • RENEW
  • REMOVE
  • REBENCH
  • CLEAN UP

• DETAILS OF DEFECT

  RECTIFY DEFECTIVE REINSTATEMENT

  RECTIFY DEFECTIVE MANHOLE COVER AND FRAME

  ROB/REMOVE OBLECT

• EQUIPMENT NEEDED

  VACTOR

  VAN PACK

  SINGLE SOLVER

• WORK TO BE DONE BY

  DLO

  CONTRACTOR

• PIPE SIZE IN MM

• PIPE MATERIAL

• DESCRIBE THE ACCESS TO THE JOB

• MANHOLE NUMBER

• MANHOLE COVER SIZE

• REPAIR LENGTH

• MANHOLE/REPAIR DEPTH

• START MANHOLE

• FINISH MANHOLE

• MANHOLE CHAMBER SIZE

• TRANSFERRED ASSET?

  YES

  NO

• COMMENTS AND DISCRIPTION OF FOW JOB

• Add media

  Media

• HAS THE ASSET BEEN TRACED AND MARKED?

  YES

  NO

• IS OVER PUMPING REQUIRED?

  YES

  NO

• IS TANKERING REQUIRED?

  YES

  NO

• ANY HAND DIG REQUIRED?

  YES

  NO

• POSITION OF FOLLOW ON WORKS

  carriageway

  Verge

  Footpath Bridleway

  Footpath next to road

  Private

• SURFACE TYPE

  Select HRA SMA BITMAC UNMADE GRASS CONCRETE SLABS BLOCKS/PAVING

  • HRA
  • SMA
  • BITMAC
  • UNMADE
  • GRASS
  • CONCRETE
  • SLABS
  • BLOCKS/PAVING

• ROAD MARKINGS

  Select WHITE LINES YELLOW LINES RED LINES

  • WHITE LINES
  • YELLOW LINES
  • RED LINES

• Other markings

• SPECIALIST TREATMENT

• WHAT TRAFFIC MANAGEMENT IS REQUIRED?

• ANY EXISTING TRAFFIC MANAGEMENT WITHIN 50M OF THE WORKS?

• IS THERE A BUS STOP WITHIN 50m OF THE WORKS? (Mark on plan and supply numbers and operator)

• ROAD WIDTH

• DISTANCE FROM KERB TO EXCAVATION/MANHOLE

• SPEED LIMIT

• IS THE WORKS CLOSE TO A BEND IN THE ROAD, ROUNDABOUT, PEDESTRIAN CROSSING OR TRAFFIC LIGHTS

  YES

  NO

• IS PARKING SUSPENSION REQUIRED?

  YES

  NO

• ARE THERE CARS PARKED AT THE TIME OF INSPECTION

  YES

  NO

• COULD THERE BE CARS PARKED ON OTHER DAYS OR AT DIFFERENT TIMES?

  YES

  NO

• WHEN

HEALTH AND SAFETY INFORMATION

• OVERHEAD POWER LINES WITHIN 10m

  YES

  NO

• LAMP SUPPORT REQUIRED OR REMOVAL

  YES

  NO

• DETAILS

• CONFINED SPACES WORKING?

  YES

  NO

• DETAILS

• Other Safety Information

• Customer Special Requirements (including preferred day or time and any special needs)