Title Page
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Conducted on
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Prepared by
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Project
Site Management
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Site Management
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Registered pipelayer?
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Registered pipelayer Onsite?
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2. Drawings on site and current?
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Occupational Health and Safety
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Occupational Health and Safety
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Appropriate PPE worn?
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Appropriate trench safety measures in place?
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Other?
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Trench Excavation
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Trench Excavation
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Section checked ?
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Trench width?
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Within tolerance?
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Pipe Laying
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Pipe Laying
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Section checked ?
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Pipe centrally placed?
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Pipe laser in use
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Pipe material
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Pipe diameter
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Pipe class
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Date of manufacture
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Embedment
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Embedment
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Section checked
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Embedment specified
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Embedment Verified
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Backfill
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Backfill
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Section checked
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Backfill type
- CR Backfill
- Clay Backfill
- Other
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Evidence of compaction
Manholes and Structures
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Manholes and Structures
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Structure(s) Checked
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Rocker pipe free of concrete
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Formwork in good condition
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Mechanical vibration used
