Southern USI Site Condition & Maintenance Report 2022

• Site Number & Location

• Conducted on

  Date

• Name of Worker Conducting Assessment

• Does this site require tracking?

  Yes

  No

• Side tracking

  Yes

  No

• What size is the site?

  12.66 x 3.35

  18.99 x 4.57

  4 x 6

  Other

• what size is the site?

• bottom tracking

  Yes

  No

• What size is the site?

  12.66 x 3.35

  18.99 x 4.57

  4 x 6

  Other

• what size is the site?

• Side tracking

  Yes

  No

• What size is the site?

  12.66 x 3.35

  18.99 x 4.57

  4 x 6

  Other

• what size is the site?

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• Yes

  No

  N/A

• Does the site require ratchets?

  Yes

  No

• How many ratchets does is required?

• Does the structure require bracing?

  Yes

  No

• Give a brief description of what needs to be fixed.

• Are there any access issues that need to be addressed? (eg. new gates, locks or keys required)

  Yes

  No

• Give a brief description of changes

• Please get a photo of the access changes.

  Media

• is there any changes/ problems to fixed ladders or catwalks? (e.g Damaged or missing hatches, broken welds or loose ladder rungs).

  Yes

  No

• give a brief description of issues.

• get a photo of any issues

  Media

• Please list any other issues that you have come across that needs to be addressed.

• Team leader onsite

• team member filing out assessment.

• Add signature

  Sign