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Site Survey Form
Site Survey Form
Shaun Bennett

Site Survey Form

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Free Site Survey Form Checklist

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Title Page

  • Site Name

  • Site Number

  • Conducted On

  • Completed By

  • Location

General

  • Proposed Works

  • Is site subject to Offtake Arrangements Documents (OAD) notice

  • Provide additional details if known

Site Access & Condition

  • Picture of site entrance from road

  • Picture of road from site entrance

  • Is the site ISS

  • What is the lock arrangement of the gate

  • What is the lock arrangement for the building

  • Is parking available on site and if so, for how many vehicles

  • If no parking available, provide additional details about where vehicles can be parked

  • Is the site in good condition

  • Provide additional details

  • Is the site shared (Distribution / Third Party)

  • Who is the site landlord

  • Is there any sign of ongoing works

  • Provide additional details

  • Existing GA drawing – list below any changes on site not shown on the drawing- mark potential new kiosk positions

  • Existing Haz area drawing – List below any changes on site not shown on the drawing – check if there is a later revision on site

  • Existing flow diagram – use this drawing to determine demarcation – check against site as far as possible, note any changes or comments below

  • Add any additional photos of site here (shared buildings, signs of asbestos, any welfare on site

Building Details

  • Building construction

  • Provide details about building access (ramp, steps any restrictions etc)

  • Building size (L x W x H) in meters

  • Door opening size (W x H) in meters

  • Is there a current asbestos report

    • Yes
    • No
    • N/A

  • Provide additional details / reference number if applicable

  • Additional notes

    • Building works required

  • Work item description

  • Is the building shared

  • Provide additional details

  • Add pictures of building exterior (from each side)

  • Add pictures of building interior (all walls)

Site Electrical Details

  • Supply Characteristics (TNS, TNCS, TT, Other)

  • Supply Type (single or three phase)

  • PSCC

  • Ze

  • Is SLD correct

  • Provide additional details

    • List electrical items to be replaced

  • Item, rating, cable length, condition, location, etc

  • Is there a 1:1 Transformer Installed

  • Provide additional details

  • Add pictures of all electrical distribution equipment here (including incomer and protection)

  • Add pictures of earthing system here

    • List electrical field items to be replaced

  • Item, rating, cable length, condition, location etc

  • Is there a permanent generator installed for back up power

  • Provide additional details

  • Is there a generator socket installed

  • Provide additional details

Site Telemetry System

  • Existing RTU system

  • Is the RTU shared with a third party

  • Who the RTU shared with

  • List any shared signals – ie NG equipment on DN’s RTU or vice versa

  • Existing panel size (W x H x D) in meters

    • Third Party Input

  • Input type and details

  • PSU system and details

  • Space available for new panel (W x H x D) in meters

  • Is there separate GRSC or satellite units? If so check NG equipment and list any of the DN’s equipment that is connected

  • Pressure transmitters – Check if any barriers are shared with DN’s (this is for multi-channel barriers) Note terminal numbers for isolations

  • ROV’s – List terminal numbers, cable numbers for isolations and any other relevant information – if NG drawings exist check against these and red-line if necessary

  • Any other equipment – list details

  • Existing BT line – List details, any numbers etc written on DP equipment etc

  • Any other information

  • Add pictures here for RTU, BT line / DP Box, UPS System, IS and Non IS barrier systems, locations for new equipment, CP equipment etc

Field Equipment

  • Is block cable diagram correct

  • Provide additional details

  • For all field equipment, ensure to get all existing information and picture evidence

    • List field instrumentation here

  • Item, EX reference number, certification, cable length, condition, location, keep or replace and photos

    • List site valves here

  • Item, EX reference number, certification, cable length, condition, location, keep or replace and photos

Site Works

  • Is a new building required

  • Size, type, colour, orientation etc

  • Are civil works required

  • Provide details, location, satellite base, cable ducts etc here and photos if relevant

  • Are cable route systems sufficient and have capacity for any new cables required

  • Provide additional details

  • Are cable routes clear and accessible

  • Provide additional details

  • Are cable draw pits / road crossings clear and accessible

  • Provide additional details

  • Check to see if the ducts are full – check at entries to buildings, main runs and if the ducting size reduces

  • Check condition of lids

  • Are the entries to the control building sealed

  • Are there any transit entries to the control building – try to get manufacturers info if possible

  • Check size of lids- can these be safely lifted by hand

  • Are the ducts suitably segregated? Power from instrument from sample lines

  • Provide additional details

  • Any other comments

CDM

  • Traffic Management Considerations (access and egress)

  • Is there space for welfare requirement

  • Provide additional details

    • List site hazards here

  • Hazard, mitigation, etc

Site Survey Form
Shaun Bennett

Site Survey Form

Use this Template
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.

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