Title Page
-
Site conducted
1.0 Property Details
-
Property ID
-
Property Address
-
Take image showing reference to house number
-
Prepared by
-
Conducted on
2.0 Take 5
-
Personal protective equipment {PPE} is appropriate ,in good condition and fitted correctly
-
If No, stop and ensure PPE is appropriate ,in good condition and fitted correctly
-
Is there access to inside the property?
-
refer to the Project Manager to reschedule time
Question Set and results
3.0 Water Meter Assembly
-
Location of water meter
- Front left side
- Front right side
- Front central
- Rear left side
- Rear right side
- Rear central
- Unable to locate
-
Is there clearance around the meter
-
Provide image from approx 1m away
4.0 Front Tap
-
if possible - Connect pressure guage to front tap outlet and provide image of the reading on the pressure guage
-
Is water supply pressure sound?
-
What is the pressure indicated
- 350-400 KPA
- 400-450 KPA
- 450-500 KPA
- 500 KPA and above- limiting valve recommended
-
Is tap in working order?
-
Prrovide image of hose cock
5.0 Bathroom 1
-
Shower -provide the flow rating from the outlet using a flow cup {Litres/min}
- 3
- 4.5
- 6
- 7.5
- 9
- 12
- 15
- 18
- 20
- Unable to test
- No fixture
-
Provide images of tapware and shower rose
-
Basin- provide the flow rating from the outlet using a flow cup {Litres/min}
- 3
- 4.5
- 6
- 7.5
- 9
- 12
- 15
- 18
- 20
- Unable to test
- No fixture
-
Provide images tapware and outlet
-
Bath -provide the flow rating from the outlet using a flow cup {Litres/min}
- 3
- 4.5
- 6
- 7.5
- 9
- 12
- 15
- 18
- 20
- Unable to test
- No fixture
-
Provide images tapware and outlet
-
Is there a Water Closet in Bathroom?
-
Cistern Type
- Low level
- Mid level
- Dual flush
- Single flush
-
Cistern Capacity
-
Provide image of pan and cistern showing isolation valve
-
Pan Type
-
Provide image at the pan outlet and floor junction
-
Seat type- disabled or non std
6.0 Other fixtures - E.G. Ensuite
-
Are there other fixtures?
-
Shower -provide the flow rating from the outlet using a flow cup {Litres/min}
- 3
- 4.5
- 6
- 7.5
- 9
- 12
- 15
- 18
- 20
- Unable to test
- No fixture
-
Provide images of tapware and shower rose and identify location of fixture
-
Basin- provide the flow rating from the outlet using a flow cup {Litres/min}
- 3
- 4.5
- 6
- 7.5
- 9
- 12
- 15
- 18
- 20
- Unable to test
- No fixture
-
Provide images tapware and outlet
-
Water Closet
-
Identify location of fixture
-
Cistern type
- Low level
- Mid level
- Dual flush
- Single flush
-
Cistern Capacity
-
Provide image of pan and cistern showing isolation valve
-
Pan type
-
Provide image at the pan outlet and floor junction
-
Seat type- disabled or non std
7.0 Kitchen
-
Kitchen Sink -provide the flow rating from the outlet using a flow cup {Litres/min}
- 3
- 4.5
- 6
- 7.5
- 9
- 12
- 15
- 18
- 20
- Unable to test
- No fixture
-
Provide images tapware and outlet
8.0 Laundry
-
Wash trough -provide the flow rating from the outlet using a flow cup {Litres/min}
- 3
- 4.5
- 6
- 7.5
- 9
- 12
- 15
- 18
- 20
- Unable to test
- No fixture
-
Provide images tapware and outlet
9.0 Other Water Closets
-
Is there another water closet?
-
Identify location of fixture
-
Cistern type
- Low level
- Mid level
- Dual flush
- Single flush
-
Cistern Capacity
-
Provide image of pan and cistern showing isolation valve
-
Pan type
-
Provide image at the pan outlet and floor junction
-
Seat type- disabled or non std
-
Is there a basin in the room ?
-
provide the flow rating from the outlet using a flow cup {Litres/min}
- 3
- 4.5
- 6
- 7.5
- 9
- 12
- 15
- 18
- 20
- Unable to test
- No fixture
-
provide images of tapware and outlet
External Sink / trough
-
Is there an external sink / trough?
-
provide the flow rating from the outlet using a flow cup {Litres/min}
- 3
- 4.5
- 6
- 7.5
- 9
- 12
- 15
- 18
- 20
- Unable to test
- No fixture
-
provide images of tapware and outlet
10.0 Hot water System
-
Water heater type
- Gas instantaneous
- Electric Instantaneous
- Gas Continuous flow
- Electric Heat Pump
- Solar water heater
- Gas storage
- Electric storage
-
Capacity {Litres}
- 80
- 125
- 135
- 180
- 220
- 250
- 270
- 300
- 310
- N/A
-
Provide images of water heater and valves
-
Is the PDRV 01 {Hot) relief valve in working order
-
Is the PDRV 02 {Cold) relief valve in working order
11.0 Rear hose cock
-
-
Is hose cock in working order?
-
Provide image of tap
Is there another hose cock?
-
Is there another hose cock?
-
Is hose cock in working order?
-
Provide image of tap
12.0 Miscellaneous
-
Are P1 Works required?
-
List issue and SOR/s if known
-
No action taken -Refered To Project Manager for actioning
-
Provide image of issue
-
Are P2 Works required?
-
List issue and SOR/s if known
-
No Action taken- details identified in report for Project Manager to action if required
Other Comments
-
undefined
13.0 Signature
-
Full name
