Title Page

  • Conducted on

  • Prepared by

  • Location
  • Project:

  • Client:

  • Contractor:

  • Site conditions:

  • Are TTM's in place and in accordance with plans?

  • Is correct PPE being used?

  • Are open trenches protected using bunting, fencing or similar?

  • Are trenches over 1.5m benched, battered or are shoring boxes in use?

  • Are materials being stored safely?

  • Are there any other safety concerns? If so detail, photograph and assign actions. Note: If there is an immediate risk to a persons safety then instruct the works to stop and contact the person in charge as well as Spiire construction team.

Environmental

  • Is contractor working in accordance with the approved EPA drawings?

  • Is dust being suppressed during excavation and backfilling of trenches?

  • Are there any other concerns regarding Environmental issues? If so detail, photograph and assign actions.

Trench Excavation

  • Does trench width conform wit Icon Water Standards and design drawings?

  • Is there any ground water present in trench? If so please detail method used for bedding and haunch and photograph.

  • Is base free from rocks and loose material?

Pipe installation

  • Are the correct revision of drawings being used by the contractor?

  • Does bedding material conform with Icon Water Standards? If so sight site specific grading certificate.

  • Are pipes and fittings all compliant with Icon Water approved products list and have they been inspected by inspector?

  • Have all SV's been signed off by Icon Water inspector?

  • Are water services installed as per design, in correct location and at correct depth?

  • Is road sub base material approved and passing grading requirements? If so sight grading certificate.

  • Is select material free form organic material and particles greater than 75mm?

  • Has tracer wire been installed and wrapped around hydrant springer head 3 times?

Finals

  • Have compaction tests been done on trench backfill and do they comply with compaction requirements?

  • Has water main pressure testing passed? Take a copy of compliance certificate and ensure serial number matches.

  • Are water services all 600mm +/- 50mm into the boundary, finishing flush with FSL and sleeve is in tact?

  • Are hydrant and SV boxes finishing flush with FSL and centred over fitting?

  • Are kerb and road markers in place and correct?

  • Are block boundary pegs in place to allow for final water inspection?

  • Comments:

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.