STW East R&M Site Feedback - Manhole Inspection

• Document No.

• STW east R&M

General information

• SAP Order nr

• Maygurney order nr

• Customer Name

• Customer contact number

• Customer mobile nr

• Site address
  Address

• Grid ref X

• Grid ref Y

• Postcode

• County

  Select Derbyshire Nottinghamshire Leicestershire Warwickshire Worcestershire Gloucestershire

  • Derbyshire
  • Nottinghamshire
  • Leicestershire
  • Warwickshire
  • Worcestershire
  • Gloucestershire

Manhole Inspection

• Location photos

  Media

• Start date / time

  Date

• Finish date / time

  Date

• Crew on site

  Select msn 1 msn 2 msn 3 msn 4 msn 5 msn 6 msn 7 msn 8 msn 9 msn 10 msn 11 msn 12

  • msn 1
  • msn 2
  • msn 3
  • msn 4
  • msn 5
  • msn 6
  • msn 7
  • msn 8
  • msn 9
  • msn 10
  • msn 11
  • msn 12

• HIGHWAY / PRIVATE / OTHER

  Select highway road private other highway verge

  • highway road
  • private
  • other
  • highway verge

• Manhole type

  Select Rising Main Foul Surface Combined N/A

  • Rising Main
  • Foul
  • Surface
  • Combined
  • N/A

• Manhole cover size

  Yes

  No

  N/A

• Surface type

  Select HRA SMA 10mm 6mm grass lawn block paving slabs concrete grass field stone hardcore soil

  • HRA
  • SMA
  • 10mm
  • 6mm
  • grass lawn
  • block paving
  • slabs
  • concrete
  • grass field
  • stone hardcore
  • soil

• Description of works / comments

• Section 81?

  Yes

  No

  N/A

• STW Asset?

  Yes

  No

  N/A

• Transferred Asset?

  Yes

  No

  N/A

• FOW required

  Yes

  No

  N/A

• FOW Priority

  Select P1 P2 P3 P4 P5 P6 P7 P8 P9

  • P1
  • P2
  • P3
  • P4
  • P5
  • P6
  • P7
  • P8
  • P9

• Replace or Reset?

  Replace

  Reset

• Cover type

  Select HD LD MD

  • HD
  • LD
  • MD

• Cover defect

  Select missing cover cracked / damaged cover polished surface rocking cover cover too low cover too high surfacing defective around cover

  • missing cover
  • cracked / damaged cover
  • polished surface
  • rocking cover
  • cover too low
  • cover too high
  • surfacing defective around cover

• FOW Traffic management

  Select chapter 8 give and take lane closure 2 way lights 3 way lights 4 way lights stop / go road closure none

  • chapter 8
  • give and take
  • lane closure
  • 2 way lights
  • 3 way lights
  • 4 way lights
  • stop / go
  • road closure
  • none

• Manhole cover size

  Select 300 dia 450 dia 450 x 600 600 x 600 675 x 675 600 x 750 750 x 750 750 x 900 900 x 900 600 x 900 675 x 1220 other

  • 300 dia
  • 450 dia
  • 450 x 600
  • 600 x 600
  • 675 x 675
  • 600 x 750
  • 750 x 750
  • 750 x 900
  • 900 x 900
  • 600 x 900
  • 675 x 1220
  • other

• Surface treatment ?

  Yes

  No

  N/A

• SCH13 quote required?

  Yes

  No

  N/A

• PTD Signed?

  Yes

  No

  Left

  N/A

• Manhole nr

Specific Site detail Information

• Road markings

  Yes

  No

  N/A

• Road Width?

• Distance Kerb - Manhole?

• Traffic Control within 50m?

  Yes

  No

  N/A

• Bus Stop within 50m?

  Yes

  No

  N/A

• Any parked cars at time?

  Yes

  No

  N/A

• Could cars park ANY time?

  Yes

  No

  N/A

• Speed limit

  Select 30 mph 40 mph 50 mph 60 mph

  • 30 mph
  • 40 mph
  • 50 mph
  • 60 mph

• Parking suspension

  Yes

  No

  N/A

• Any hand dig required?

  Yes

  No

  N/A

• Traced and Marked?

  Yes

  No

  N/A

Safety Information

• Overhead Power?

  Yes

  No

  N/A

• Lamp Support Required?

  Yes

  No

  N/A

• Confined Space Working?

  Yes

  No

  N/A

• Customer Special Requirements?

  Yes

  No

  N/A

• If Yes, state them here.

• Any Other Safety Information?

• Draw sketch here if required.

  Drawing