Title Page

  • Supervisor Auditor Name

  • Date & Time

  • Location
  • Local Authority Area

  • Client Name

  • Partner Name or Direct Labour

  • Ganger Name

  • Operative 1 Name

  • Operative 2 Name

  • Project Reference

  • Does your works require a street works permit?

  • Insert your permit reference number and ensure it is displayed on a permit board.

Audit Questions

  • Do you have a Gate Guard and any other required SLG?

  • STOP - cannot enter a chamber unless the public and workforce are protected from entering it.

    Risk of injury.jpg
  • Do you have an in date calibrated Gas Detector?

  • You CANNOT enter a chamber without an in date calibrated Gas Detector.

    STOP sign.jpg
  • Do you have the correct Lifting Key/Lifting Device and Roller Bar where required?

  • DO NOT attempt to remove a chamber cover without the correct lifting equipment.

    Risk of serious injury.jpg
  • Now remove the chamber cover and conduct a gas test. Proceed ONLY when gas is detected below safe levels for entry.

    Proceed with caution.jpg
  • Has the chamber been constructed on a concrete base (at least 120mm of the bottom section remaining)

  • Now raise a defect by following the defect process and assign actions where necessary.

    Action required.jpg
  • Is there a floated finish cement floor visible? (MUST have a sump and grate if F/W 4 chamber or above)

  • Now raise a defect by following the defect process and assign actions where necessary.

    Action required.jpg
  • Is there the correct number of chamber sections present? (FW2 = 3, FW4 = 4, FW6 = 5, FW10 = 6)

  • Now raise a defect by following the defect process and assign actions where necessary.

    Action required.jpg
  • Duct entries are not allowed in the top or bottom sections, are they?

  • Now raise a defect by following the defect process and assign actions where necessary.

    Action required.jpg
  • Are all duct entries at least 75mm from the inside chamber sides, and at least 25mm apart if more than 1 entry?

  • Now raise a defect by following the defect process and assign actions where necessary.

    Action required.jpg
  • Are all duct entries cut flush and sealed with SILICONE based sealer?

  • Now raise a defect by following the defect process and assign actions where necessary.

    Action required.jpg
  • Is the Cover & Frame sat on a mortar bed? (appx 25mm)

  • Now raise a defect by following the defect process and assign actions where necessary.

    Action required.jpg
  • Is the frame sat within + or - 6mm of the surrounding surface level?

  • Now raise a defect by following the defect process and assign actions where necessary.

    LA Inspection Fail.jpg
  • When closed, does the cover sit snug inside the frame with no corners lifted or trips present?

  • Now raise a defect by following the defect process and assign actions where necessary.

    Warning - High Risk Inspection Fail.jpg
  • Is the surrounding surface Tarmac or Verge?

  • Is the tarmac around the frame trimmed back to at least 170mm?

  • Now raise a defect by following the defect process and assign actions where necessary.

    LA Inspection Fail.jpg
  • Is there a 150mm concrete surround fitted around the chamber?

  • Now raise a defect by following the defect process and assign actions where necessary.

    Action required.jpg
  • Please sign your audit and submit.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.