Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Customer Information / Job Details

  • Name

  • Address

  • Contact

  • S/O Number

  • Commit Date

Health, Safety and Environmental

  • Ceiling access?

  • Hatches Required?

  • Drilling Required?

  • Services Located?

  • Fire Stopping Required?

  • Underfloor Access?

  • ETP located?

  • Pipe direct into house?

  • Dogs on site?

  • Digging in road reserve required?

Consents Required

  • Landlord Consent?

  • Right of Way?

  • Protected Trees (Arborist Required on site)?

  • Heritage Building?

  • Heritage Land?


  • Fibre Type?

  • Network type?

  • 50mm Drop Off Installed Correctly?

  • Water in pits/manholes?

  • FAT Location?

  • FAT ID

  • Length of haul / blow?

  • Distance from FAT to boundary drop?

  • Distance from boundary drop to ETP?

Civil Required

  • Hand dig?

  • Drill?

  • Grundomat?

  • Hydro excavation?

  • Hauling tapes in place?

  • Do the tapes move?

  • Do the tapes go to the correct FAT?

Reinstatement Required

  • Concrete?

  • Grass / Soft surface?

  • Tar seal?

Additional Information or notes

  • Notes

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.