Date & Time

Land Classification

Type of Work

Surface type
Take Condition photographs of patch before any work commences.
Open meter lid and take photo of meter face
Take completed job photo
Take final wide street view photo after wash down and site has been cleared

Location of new meter box ( e.g. Footway, verge)

Input box distance & direction from any clearly visible structures ( ie 500 from boundary wall, LHS of brick pier )

Surface Reinstatement

Job completed

Comment / Reason why not completed

Gang Name & Signature
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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.