Title Page
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Report Type
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PIANO ID
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Type
- Blockage
- Duct
- Chamber
- Pole
- TM
- Defect
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Date
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Supervisor
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Location
Health & Safety
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Safe Digs Cover Excavation Area
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Is this a HOT JOB?
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Speed of road
- 20mph
- 30mph
- 40mph
- 50mph orAbove
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TM Required?
- Give & Take Only
- 2 Way Lights
- 3 Way Lights
- 4 Way Lights
- Road / Lane Closure
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HV Lines in vicinity?
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Confined Space Access Required
Pre-Site
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Pre-Site photos including any existing damage
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Location photos from each direction
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Private or Public Maintainable Land?
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OOH Required?
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CAT & GENNY Used to locate services? If yes add marked up photos
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Photos of duct entry point inside chamber (only access if safe to do so)
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Parked Cars - Letter Drop Required
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Any Access Restrictions For Vehicles & Plant
Reinstatement Requirements
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Type
- Verge / Top Soil
- Unsurfaced Stone
- Tar F/w (6mm)
- Tar C/w (10mm)
- Concrete
- Modular
- SMA, HRA, Other
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Reinforced?
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Is New Duct Required?
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Provide breakdown measures of each surface (e.g 4.6m x Tar FW, 7.2m x Slab F/w, 8.0m x C/W)
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Same Day Reinstatement Required?
Job Validation
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A55 fit for purpose?
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JIRA Ticket Required?
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Comments / Additional Info
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Confirmation
