Title Page
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Site conducted
1.0 Property Details
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Property ID
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Property Address
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Take image showing reference to house number
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Prepared by
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Conducted on
2.0 Take 5
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2.1 Are there any identified risks?
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2.2 Identify that risk
- Covid/ flue
- animals not restrained
- Agressive tenant
- Inclement weather
- Other
- Building condition unsafe
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2.3 Personal protective equipment {PPE} is appropriate ,in good condition and fitted correctly
Question Set and results
3.0 Water Meter Assembly
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Location of water meter
- Front left side
- Front right side
- Front central
- Rear left side
- Rear right side
- Rear central
- Unable to locate
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Is there clearance around the meter
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Provide image from approx 1m away
4.0 Front Tap
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if possible - Connect pressure guage to front tap outlet and provide image of the reading on the pressure guage
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4.1 Is water supply pressure sound?
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What is the pressure indicated
- 350-400 KPA
- 400-450 KPA
- 450-500 KPA
- 500 KPA and above- limiting valve recommended
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Is tap in working order?
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Provide image of hose cock
5.0 Internal property access
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Is there access to inside the property
5.1 Kitchen
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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
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Provide images tapware and outlet
5.2 Laundry
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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
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Provide images tapware and outlet
5.3 Water Closets
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Is there another water closet?
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Identify location of fixture
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Cistern type
- Low level
- Mid level
- Dual flush
- Single flush
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Cistern Capacity
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Provide image of pan and cistern showing isolation valve
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Pan type
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Provide image at the pan outlet and floor junction
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Seat type- disabled or non std
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5.31 Is there a basin in the room ?
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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
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provide images of tapware and outlet
5.4 Bathroom 1
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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
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Provide images of tapware and shower rose
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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
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Provide images tapware and outlet
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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
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Provide images tapware and outlet
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5.41 Is there a Water Closet in Bathroom?
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Cistern Type
- Low level
- Mid level
- Dual flush
- Single flush
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Cistern Capacity
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Provide image of pan and cistern showing isolation valve
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Pan Type
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Provide image at the pan outlet and floor junction
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Seat type- disabled or non std
5.5 Other fixtures - E.G. Ensuite
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5.51 Are there other fixtures?
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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
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Provide images of tapware and shower rose and identify location of fixture
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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
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Provide images tapware and outlet
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5.52 Water Closet
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Identify location of fixture
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Cistern type
- Low level
- Mid level
- Dual flush
- Single flush
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Cistern Capacity
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Provide image of pan and cistern showing isolation valve
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Pan type
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Provide image at the pan outlet and floor junction
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Seat type- disabled or non std
5.6 External Sink / trough
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5.61 Is there an external sink / trough?
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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
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provide images of tapware and outlet
5.7 Hot water System
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Water heater type
- Gas instantaneous
- Electric Instantaneous
- Gas Continuous flow
- Electric Heat Pump
- Solar water heater
- Gas storage
- Electric storage
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Capacity {Litres}
- 80
- 90
- 125
- 135
- 180
- 220
- 250
- 270
- 300
- 310
- N/A
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Provide images of water heater and valves
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Are relief valves in working order-
- PTRV01
- PDRV02
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Is there a tempering valve visible?
5.8 Rear hose cock
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Is hose cock in working order?
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Provide image of tap
5.81 Is there another hose cock?
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Is there another hose cock?
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Is hose cock in working order?
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Provide image of tap
6.0 Miscellaneous
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Is a maintenance Work Order required?
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15.1 Are P1 Works required?
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List issue and SOR/s if known
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No action taken -Refered To Project Manager for actioning
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Provide image of issue
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15.2 Are P2 Works required?
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List issue and SOR/s if known
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No Action taken- details identified in report for Project Manager to action if required
7.0 Other Comments
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8.0 Completion Sign off
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Completion date
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Full name
