Title Page

  • Specific Work Type

  • What time did you set off to come to this job? (includes travel time and tar collection)?

  • How long were you onsite (minimum duration 1hr & including time to travel back to original location)

  • How much asphalt (tonnes) have you used (including base and surface course) example: 2 x Barrows base = 0.2t

  • Feature ID

  • Exchange

  • Date

  • Gang Lead

  • Location

Health & Safety

  • Have you completed a Risk Assessment (Ensure Safe Digs are in date & Cover Excavation Area) Upload pic of completed POWRA form.

  • STOP work! Why haven't you completed a RA. EVERY job requires you to complete a suitable risk assessment

Pre-Start

  • Provide a minimum of 4 Pre-Start photos, at least one from all directions of excavation area (Take photos of immediate surroundings to show existing conditions and to protect yourself from any potential damage claims)

  • Provide Site Set-up photos at least one from each direction clearly showing the CORRECT Chapter 8 in place. Ensure your site is secure and fully barriered off to prevent public access.

Reinstatement Evidence

  • Provide photos of cut back and show depth of existing surface (Use Tape measure / Depth board)

  • Photos of edge sealant on all vertical edges

  • Photo of compacted backfill including aspect view at least 5m radius (NOT JUST A CLOSE UP)

  • Reinstatement MUST comply to HAUC Specification not just matching existing surface. Carefully select the correct method from this document. Refer to full specification in the HAUC if necessary

  • Reinstatement Type

  • Provide Reinstatement photos showing depth measure of base course. You MUST include a perspective view photo of at least 5m radius otherwise it will fail validation (DO NOT JUST TAKE A CLOSE UP PIC)

  • Provide Reinstatement photos showing depth measure of surface course. You MUST include a perspective view photo of at least 5m radius otherwise it will fail validation (DO NOT JUST TAKE A CLOSE UP PIC)

Job Completion

  • Dig dimensions: length x Width - Breakdown measures by surface/Type (e.g FW = 3.4m x 0.4m, CW = 8.2m x 0.3m) or (Chamber = 1.9m x 1.3m - F/w, Duct = 1.7m x 0.4m - F/w)

  • Does reinstatement exceed 3m?

  • Record Grid Reference at Start Point
  • Record Grid Reference at End Point
  • Is all reinstatement Complete

  • Provide site clear photos from both directions

  • Provide photos of site left safe & secure until return visit

  • Please add any additional relevant information

Confirmation

  • Gang Lead Signature

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.