Title Page

  • Specific Work Type

  • Feature ID

  • Exchange

  • Date

  • Gang Lead

  • Location

Health & Safety

  • Have You Completed A Risk Assessment (EVERY JOB requires a RA upload pic of completed form)

Pre-Site

  • Pre-Start photos (Take photos of immediate surroundings to show existing conditions and to protect yourself from any potential damage claims)

  • Site Set-up photos from each direction showing safe set-up

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

  • Reinstatement photos showing depth of base course including aspect view at least 5m radius (NOT JUST A CLOSE UP)

  • Reinstatement photos showing depth of surface course including aspect view at least 5m radius (NOT JUST A CLOSE UP)

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.