Ward 19 Drains

• Conducted on

  Date

Bed space 1

• Access Granted?

  Yes

  No

  N/A

• Drain Inspected , Sediment Present Y/N

  No Sediment

  Sediment

• Drain Cleaned Y/N

  Yes

  No

  N/A

• Drain Cleaned Y/N

  Yes

  No

  N/A

• Drain Cleaned Y/N

  Yes

  No

  N/A

Bed Space 2

• Access Granted?

  Yes

  No

  N/A

• Drain Inspected , Sediment Present Y/N

  No Sediment

  Sediment

• Drain Cleaned Y/N

  Yes

  No

  N/A

• Drain Cleaned Y/N

  Yes

  No

  N/A

• Drain Cleaned Y/N

  Yes

  No

  N/A

Bed Space 3

• Access Granted?

  Yes

  No

  N/A

• Drain Inspected , Sediment Present Y/N

  No Sediment

  Sediment

• Drain Cleaned Y/N

  Yes

  No

  N/A

• Drain Cleaned Y/N

  Yes

  No

  N/A

• Drain Cleaned Y/N

  Yes

  No

  N/A

Bed Space 4

• Access Granted?

  Yes

  No

  N/A

• Drain Inspected , Sediment Present Y/N

  No Sediment

  Sediment

• Drain Cleaned Y/N

  Yes

  No

  N/A

• Drain Cleaned Y/N

  Yes

  No

  N/A

• Drain Cleaned Y/N

  Yes

  No

  N/A

Bed Space 5

• Access Granted?

  Yes

  No

  N/A

• Drain Inspected , Sediment Present Y/N

  No Sediment

  Sediment

• Drain Cleaned Y/N

  Yes

  No

  N/A

• Drain Cleaned Y/N

  Yes

  No

  N/A

• Drain Cleaned Y/N

  Yes

  No

  N/A

Bed Space 6

• Access Granted?

  Yes

  No

  N/A

• Drain Inspected , Sediment Present Y/N

  No Sediment

  Sediment

• Drain Cleaned Y/N

  Yes

  No

  N/A

• Drain Cleaned Y/N

  Yes

  No

  N/A

• Drain Cleaned Y/N

  Yes

  No

  N/A

Bed Space 7

• Access Granted?

  Yes

  No

  N/A

• Drain Inspected , Sediment Present Y/N

  No Sediment

  Sediment

• Drain Cleaned Y/N

  Yes

  No

  N/A

• Drain Cleaned Y/N

  Yes

  No

  N/A

• Drain Cleaned Y/N

  Yes

  No

  N/A

Bed Space 8

• Access Granted?

  Yes

  No

  N/A

• Drain Inspected , Sediment Present Y/N

  No Sediment

  Sediment

• Drain Cleaned Y/N

  Yes

  No

  N/A

• Drain Cleaned Y/N

  Yes

  No

  N/A

• Drain Cleaned Y/N

  Yes

  No

  N/A

Reviewed By

• Print

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• Signature

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