Trunk Main Survey

• Job Reference:

• Address:

• Conducted on

  Date

• Personnel

  Select

• Number of Valves to Check:

• Select from range

undefined

• Yes

  No

  N/A

• Number of FH to Check:

• Details of Assets Checked

Asset
• Address of Asset:
  Address

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

• Asset Type:

  Select Fire Hydrant Valve Boundary Valve Emptying Valve Wash Out Chamber

  • Fire Hydrant
  • Valve
  • Boundary Valve
  • Emptying Valve
  • Wash Out
  • Chamber

• Has the Asset Been Located?

  Yes

  No

• Reason:

  Select

• Was the area box located?

  Yes

  No

• Is an extension trace required?

  Select YES - Traced on site to continue asset check YES - Office support required NO

  • YES - Traced on site to continue asset check
  • YES - Office support required
  • NO

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

  Media

• Is the Asset Operable/Working

  Yes

  No

  Unsure

  Unable to Check

• Valve Key Spindle.

  Select Stop Cock Standard Key Medium Key Jumbo Key Jumbo Jumbo Jey Jumbo Jumbo Extention spindle Large Asset Key Smart Top Wiz Key Short Key Actuator Hand Wheel

  • Stop Cock
  • Standard Key
  • Medium Key
  • Jumbo Key
  • Jumbo Jumbo Jey
  • Jumbo Jumbo Extention spindle
  • Large Asset Key
  • Smart Top
  • Wiz Key
  • Short Key
  • Actuator
  • Hand Wheel

• Depth to Valve Spindle

• Is the valve silent? (No noise heard)

  Yes

  No

• Direction of Shut

  Select Clockwise (Right Hand Shut) Anti-Clockwise (Left Hand Shut) Unsure Actuator

  • Clockwise (Right Hand Shut)
  • Anti-Clockwise (Left Hand Shut)
  • Unsure
  • Actuator

• Position of valve.

  Shut

  Open

  Unsure

• Number of turns used to check

• Does the Asset Require Any Work or Repairs?

  Yes

  No

• If Yes Select The Relevant Options:

  Select

• Is an extension trace required?

  No

  YES - Traced on site

  YES - Office support required

• Reason:

  Select

• Depth to Valve Spindle

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

  Media

• Has the Asset Been Located?

  Yes

  No

• Reason:

  Select

• Was the area box located?

  Yes

  No

• Is an extension trace required?

  Select YES - Traced on site to continue asset check YES - Office support required NO

  • YES - Traced on site to continue asset check
  • YES - Office support required
  • NO

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

  Media

• Is the Asset Operable/Working

  Yes

  No

  Unsure

  Unable to Check

• Does the Asset Require Any Work or Repairs?

  Yes

  No

• If Yes Select The Relevant Options:

  Select

• Reason:

  Select

• Is an extension trace required?

  No

  YES - Traced on site

  YES - Office support required

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

  Media

• Additional Comments

Summary

Signature

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

  Manual

  Visual

• Date and Time

  Date

• Final Comments

• Signature Required

  Sign