Audit

INITIAL INSPECTION
JOB PRIORITY

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

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

PROPOSED WORK DETAILS (inc TM)

Manhole Number

Manhole cover size

Is STW Asset

Start Manhole

Finish Manhole

Manhole Chamber Size

COMMENTS/DESCRIPTION OF JOB (Inc Photos)

Add media

Transferred Asset

Section 81 Manhole

Type of Cover

Any Hand Dig Required

Road Width

Road Markings

Position of follow on works

Surface type

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

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

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

Lamp Support Required or Removal

Details

Confined Space Working

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
Time off site
JOB PRIORITY

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

12 Figure Grid Reference (Of Defect)

Location of FOW

PROPOSED WORK DETAILS (inc TM)

Manhole Number

Manhole cover size

Manhole Type

Is STW Asset

COMMENTS/DESCRIPTION OF JOB (Inc Photos)

Add media

Transferred Asset

Section 81 Manhole

Any Hand Dig Required

Type of Cover

Has the asset been traced and marked

Position of follow on works
Surface type

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

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

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

Lamp Support Required or Removal

Details

Confined Space Working

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

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?
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

Is CCTV Done

Is Evidence Rcorded

Has The Line Been Rodded or Jetted

What Was The Cause?

Percentage of Cause

PROPOSED WORK DETAIL FOR FOW(Inc TM)
ASSET
TASK

DETAILS OF DEFECT

EQUIPMENT NEEDED

WORK TO BE DONE BY

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?

COMMENTS AND DISCRIPTION OF FOW JOB

Add media

HAS THE ASSET BEEN TRACED AND MARKED?

IS OVER PUMPING REQUIRED?

IS TANKERING REQUIRED?

ANY HAND DIG REQUIRED?

POSITION OF FOLLOW ON WORKS

SURFACE TYPE
ROAD MARKINGS

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

IS PARKING SUSPENSION REQUIRED?

ARE THERE CARS PARKED AT THE TIME OF INSPECTION

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

WHEN

HEALTH AND SAFETY INFORMATION

OVERHEAD POWER LINES WITHIN 10m

LAMP SUPPORT REQUIRED OR REMOVAL

DETAILS

CONFINED SPACES WORKING?

DETAILS

Other Safety Information

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

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.