Title Page

  • Prepared by / Nume

  • Other operatives on site

  • Project Area / Zonă

  • Works address and description / Adresa și descrierea lucrărilor

  • Job Number

  • Date and Time / Data si ora

  • Permit Number / Număr permis

  • Location Coordinates / Coordonatele locației
  • If the job cannot be done give full details of all further works required

  • If the blockage has been cancelled, why?

  • What surface are the digs on?

  • Soft reinstatement type

  • Number of digs in soft

  • Dimensions of dig 1 in soft

  • Dimensions of dig 1 in soft

  • Dimensions of dig 2 in soft

  • Dimensions of dig 1 in soft

  • Dimensions of dig 2 in soft

  • Dimensions of dig 3 in soft

  • Dimensions of dig 1 in soft

  • Dimensions of dig 2 in soft

  • Dimensions of dig 3 in soft

  • Dimensions of dig 4 in soft

  • Dimensions of dig 1 in soft

  • Dimensions of dig 2 in soft

  • Dimensions of dig 3 in soft

  • Dimensions of dig 4 in soft

  • Dimensions of dig 5 in soft

  • Dimensions of dig 1 in soft

  • Dimensions of dig 2 in soft

  • Dimensions of dig 3 in soft

  • Dimensions of dig 4 in soft

  • Dimensions of dig 5 in soft

  • Dimensions of dig 6 in soft

  • FW reinstatement type

  • Number of digs in fw

  • Dimensions of dig 1 in fw

  • Dimensions of dig 1 in fw

  • Dimensions of dig 2 in fw

  • Dimensions of dig 1 in fw

  • Dimensions of dig 2 in fw

  • Dimensions of dig 3 in fw

  • Dimensions of dig 1 in fw

  • Dimensions of dig 2 in fw

  • Dimensions of dig 3 in fw

  • Dimensions of dig 4 in fw

  • Dimensions of dig 1 in fw

  • Dimensions of dig 2 in fw

  • Dimensions of dig 3 in fw

  • Dimensions of dig 4 in fw

  • Dimensions of dig 5 in fw

  • Dimensions of dig 1 in fw

  • Dimensions of dig 2 in fw

  • Dimensions of dig 3 in fw

  • Dimensions of dig 4 in fw

  • Dimensions of dig 5 in fw

  • Dimensions of dig 6 in fw

  • CW reinstatement type

  • Number of digs in cw

  • Dimensions of dig 1 in cw

  • Dimensions of dig 1 in cw

  • Dimensions of dig 2 in cw

  • Dimensions of dig 1 in cw

  • Dimensions of dig 2 in cw

  • Dimensions of dig 3 in cw

  • Dimensions of dig 1 in cw

  • Dimensions of dig 2 in cw

  • Dimensions of dig 3 in cw

  • Dimensions of dig 4 in fw

  • Dimensions of dig 1 in cw

  • Dimensions of dig 2 in cw

  • Dimensions of dig 3 in cw

  • Dimensions of dig 4 in cw

  • Dimensions of dig 5 in cw

  • Dimensions of dig 1 in fw

  • Dimensions of dig 2 in fw

  • Dimensions of dig 3 in fw

  • Dimensions of dig 4 in fw

  • Dimensions of dig 5 in fw

  • Dimensions of dig 6 in fw

  • Dig 1

  • Photo of the open dig(s) - with BOTH zoomed in and zoomed out photos, showing part of the surrounding area

  • Photo of dig(s) depth with tape measure

  • Photo of dig(s) length with tape measure

  • Photo of dig(s) width with tape measure

  • Photo of site shut down (all tools and rubbish removed). Clearly show the repair patch and surrounding area

  • Photo of blockage(s) repaired - with BOTH zoomed in and zoomed out photos, showing part of the surrounding area

  • Clear photo of A55 with exact location of blockage

  • What3Words location - showing exact coordinates and address of dig(s)

  • Actual address of blockage

  • Dig 2

  • Photo of the open dig(s) - with BOTH zoomed in and zoomed out photos, showing part of the surrounding area

  • Photo of dig(s) depth with tape measure

  • Photo of dig(s) length with tape measure

  • Photo of dig(s) width with tape measure

  • Photo of site shut down (all tools and rubbish removed). Clearly show the repair patch and surrounding area

  • Photo of blockage(s) repaired - with BOTH zoomed in and zoomed out photos, showing part of the surrounding area

  • What3Words location - showing exact coordinates and address of dig(s)

  • Actual address of blockage

  • Dig 3

  • Photo of the open dig(s) - with BOTH zoomed in and zoomed out photos, showing part of the surrounding area

  • Photo of dig(s) depth with tape measure

  • Photo of dig(s) length with tape measure

  • Photo of dig(s) width with tape measure

  • Photo of site shut down (all tools and rubbish removed). Clearly show the repair patch and surrounding area

  • Photo of blockage(s) repaired - with BOTH zoomed in and zoomed out photos, showing part of the surrounding area

  • What3Words location - showing exact coordinates and address of dig(s)

  • Actual address of blockage

  • Dig 4

  • Photo of the open dig(s) - with BOTH zoomed in and zoomed out photos, showing part of the surrounding area

  • Photo of dig(s) depth with tape measure

  • Photo of dig(s) length with tape measure

  • Photo of dig(s) width with tape measure

  • Photo of site shut down (all tools and rubbish removed). Clearly show the repair patch and surrounding area

  • Photo of blockage(s) repaired - with BOTH zoomed in and zoomed out photos, showing part of the surrounding area

  • What3Words location - showing exact coordinates and address of dig(s)

  • Actual address of blockage

  • Dig 5

  • Photo of the open dig(s) - with BOTH zoomed in and zoomed out photos, showing part of the surrounding area

  • Photo of dig(s) depth with tape measure

  • Photo of dig(s) length with tape measure

  • Photo of dig(s) width with tape measure

  • Photo of site shut down (all tools and rubbish removed). Clearly show the repair patch and surrounding area

  • Photo of blockage(s) repaired - with BOTH zoomed in and zoomed out photos, showing part of the surrounding area

  • What3Words location - showing exact coordinates and address of dig(s)

  • Actual address of blockage

  • Dig 6

  • Photo of the open dig(s) - with BOTH zoomed in and zoomed out photos, showing part of the surrounding area

  • Photo of dig(s) depth with tape measure

  • Photo of dig(s) length with tape measure

  • Photo of dig(s) width with tape measure

  • Photo of site shut down (all tools and rubbish removed). Clearly show the repair patch and surrounding area

  • Photo of blockage(s) repaired - with BOTH zoomed in and zoomed out photos, showing part of the surrounding area

  • What3Words location - showing exact coordinates and address of dig(s)

  • Actual address of blockage

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.