Title Page

  • Job Reference:

  • Address:

  • Conducted on

  • Personnel

  • Number of Valves to Check:

  • Select from range

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  • Number of FH to Check:

  • Details of Assets Checked

  • Asset
  • Address of Asset:
  • Please Enter Asset Reference (I.E Location A, Valve 1)

  • Asset Type:

  • Has the Asset Been Located?

  • Reason:

  • Was the area box located?

  • Is an extension trace required?

  • Photographs of Location - If You Are Unable To Locate.

  • Is the Asset Operable/Working

  • Valve Key Spindle.

  • Depth to Valve Spindle

  • Is the valve silent? (No noise heard)

  • Direction of Shut

  • Position of valve.

  • Number of turns used to check

  • Does the Asset Require Any Work or Repairs?

  • If Yes Select The Relevant Options:

  • Is an extension trace required?

  • Reason:

  • Depth to Valve Spindle

  • Photographs are required that show the typical layout and markings of nearby roads.

  • Has the Asset Been Located?

  • Reason:

  • Was the area box located?

  • Is an extension trace required?

  • Photographs of Location - If You Are Unable To Locate.

  • Is the Asset Operable/Working

  • Does the Asset Require Any Work or Repairs?

  • If Yes Select The Relevant Options:

  • Reason:

  • Is an extension trace required?

  • Photographs are required that show the typical layout and markings of nearby roads.

  • Additional Comments

Summary

    Signature
  • Is this site visit for a Manual or Visual check of the assets?

  • Date and Time

  • Final Comments

  • Signature Required

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