Title Page
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Project
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Council Representative
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Council
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Conducted on
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Prepared by
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Document No.
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Verify ROAD personnel (pipe layer and site supervisor) are current
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Qualification of operators current<br>
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Trench Safety Awareness Supervisor nominated<br>
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NAME:
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Worksafe has been notified of the works <br>
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Traffic control requirements identified<br>
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Control and protection of public identified<br>
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Storage area of materials and equipment identified<br>
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Three (3) temporary bench marks identified<br>
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Setout survey completed<br>
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Road opening permits secured<br>
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Current construction drawings and specification on hand<br>
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REVISION:
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Services and obstructions identified / Authorities advised<br>
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MOCS:
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Confirm existing connection levels prior to commencement of pipe laying and boxing.<br>
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Contractor to cater for surveyors (Refer NOTE)<br>
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Reinforce live services access/connection requirements (Refer NOTE)<br>
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Detailed report/photos taken of adjoining properties/infrastructure<br>
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Site Management Plan – reference to JSA, SWMS, Toolbox<br>
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Confined Space Entry form to be completed and forwarded to Consultant and relevant Authority
Connection to Live Assets form to be completed and forwarded to Consultant and relevant Authority
Contractor to advise Consultant five (5) clear days prior to requirement for testing of assets
ALL soft subgrade MUST be inspected by Superintendent otherwise at Contractor risk and costs.
Contractor to advise Consultant five (5) clear days prior to requirement for surveyors
Contractor to advise Consultant five (5) clear days prior to undertaking works within road reservation incl. copy of approved TMP
Contractor to advise Consultant five (5) clear days prior to undertaking works within private land
Variations MUST be reported to the Superintendent before proceeding further otherwise at Contractor risk of NCR and costs.
ANY deviation from approved plans must be informed to Superintendent prior otherwise at Contractor risk of NCR and costs.
