Chris Jones

Smart Networks Chamber Inspection

E&C Contractor manhole inspection and audit

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Use this Template

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Title Page

Site conducted
Conducted on
Company
Prepared by
Location
Sheet No.
Asset ID

Safety

Have you Completed a SWMS?
Are there any hazards not identified by the work instruction?
- Safe
- At Risk
- N/A
please list risks and your controls
Does the site require WZTM?
Please note the field book reference
take photo of plan or actual set up
take photo of work zone

Preperation

Asset ID
photo of valve or fireplug before works
location, please select as close a possible to the manhole on map
depth to road surface from mounting plate
can plate be mounted
take photo
please take photo of installed plate
Has site been tidied and left in a safe manner?
take photo of tidied site before leaving

Chris Jones

Smart Networks Chamber Inspection

E&C Contractor manhole inspection and audit

Use this Template

Print as PDF

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.