Drainage Inspection Checklist

General Information

Drainage area

Pipe length

Pipe size

Distance to block age from the manhole

Is this a recurrence of an incident?

Please note that this checklist is an example and provides basic information only. It’s not intended to replace professional advice
or applicable requirements related to the topic of the template, your type of business or scope of production.
You are invited to request customized professional consultancy from our freelance top talented and trusted experts: http://food-
sight.com/services/
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Nature of Incident

Consequence of the problem

Blockage Flooding Pollution Odor Over-flowing drain Blocked sink Others

Structural Causes

Interceptor trap broken pipe / Broken pipe material or brick at the blockage site Other
Displaced joint

Work Undertaken

Action Taken

Rodded Jetted Aborted visit Washed down Drain Chemicals Plunger / Drain wire
Other

Outcome of Work

Drain unblocked Public drain unable to clear Block age in neighbor’s property Revisit
Other

Further Action Required

Yes No N/A

Completion

Recommendations

Personnel (Full Name and Signature)

Please note that this checklist is an example and provides basic information only. It’s not intended to replace professional advice
or applicable requirements related to the topic of the template, your type of business or scope of production.
You are invited to request customized professional consultancy from our freelance top talented and trusted experts: http://food-
sight.com/services/
2