Title Page

General

  • Audit Title

  • Document No.

  • Contract

  • Total Eden

  • Other

Valve Asset Number

Valve location

  • Location

  • Chainage

Observer

  • Observer

  • Conducted on

Time on Site

  • Arrive

  • Depart

  • Locking bar is easily removed?

  • Padlock Installed?

  • Lid of pit is easily removed?

  • Pit is a minimum of 500mm above the local ground level?

  • Drainage holes in pit are drilled sufficiently below top of air valve, and at least 100mm above ground level?

  • Air valve & butterfly/ball valve are operating correctly?

  • No leaks present?

  • Riser bolted flanges are dense wrapped if below ground?

  • Clean aggregate in base of pit for drainage?

  • There is no subsidence around pit?

  • Excess water can drain away from pit?

  • Marker & bollard are securely installed?

  • There is no rubbish in or around pit?

  • There are no other issues?

Sketches

  • Add drawing

Photos

  • Add media

Sign Off

  • Add signature

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.