General information

SAP Order nr

Maygurney order nr

Customer Name

Customer contact number

Customer mobile nr

Site address

Grid ref X

Grid ref Y


Manhole Inspection
Location photos
Start date / time
Finish date / time
Crew on site
Manhole type

Manhole cover size

Surface type

Description of works / comments

Section 81?

STW Asset?

Transferred Asset?

FOW required

FOW Priority

Replace or Reset?

Cover type
Cover defect
FOW Traffic management
Manhole cover size

Surface treatment ?

SCH13 quote required?

PTD Signed?

Manhole nr

Specific Site detail Information

Road markings

Road Width?

Distance Kerb - Manhole?

Traffic Control within 50m?

Bus Stop within 50m?

Any parked cars at time?

Could cars park ANY time?

Speed limit

Parking suspension

Any hand dig required?

Traced and Marked?

Safety Information

Overhead Power?

Lamp Support Required?

Confined Space Working?

Customer Special Requirements?

If Yes, state them here.

Any Other Safety Information?

Draw sketch here if required.
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.