Title Page
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Conducted on
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Prepared by
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Project
Water types checked
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- Drinking Water
- Non-drinking Water
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Site Management
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Site Management
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Registered Pipelayer
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Onsite?
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Occupational Health and Safety
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Occupational Health and Safety
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PPE as per site rules being worn.
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Trench Excavation (MRWA-W-202)
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Trench Excavation (MRWA-W-202)
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Section checked ?
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Depth of trench
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Required minimum depth (TABLE 202-A: TRENCH DIMENSIONAL DETAILS)
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Depth of trench
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Width of trench
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Required minimum width (TABLE 202-A: TRENCH DIMENSIONAL DETAILS)
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Width of trench
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Pipe Laying (MRWA-W-103)
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Pipe Laying (MRWA-W-103)
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Section checked ?
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Pipe material
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Pipe Dia.
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Date of manufacture
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Within last 12 months?
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Pipe alignment as per drawings (DW and NDW on correct sides)
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Witness marks sighted?
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Witness mark distance from end of pipe (pipe to pipe connection) (MRWA-W-103 Table 2) _____________mm
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Inserted witness mark distance from socket end. _________mm
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Witness Mark Compliant?
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Witness Mark Visible?
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Witness Mark within 5mm?
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Embedment and backfill (MRWA-W-201)
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Embedment and backfill (MRWA-W-201)
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Section checked ?
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Embedment material
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Compliant?
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Embedment depth under pipe
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Compliant?
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Embedment cover over pipe
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Compliant?
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Area
- Trafficable Area
- Non-trafficable area
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Clay backfill Compliant
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CR backfill Compliant?
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Pipe
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Fittings
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Welding
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Clearances to other services (WSA03 Table5.2)
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Property Connections
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Thrust blocks (MRWA-W-205A and 205B)
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Thrust blocks (MRWA-W-205A and 205B)
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Section checked
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Thrust blocks founded against undisturbed soil Compliant
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Reinforcement installed and correct size Compliant
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Thrust block sides have been formed using timber or sand bags Compliant
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