TRIAL PIT INSPECTION REPORT

Date :…………………… ………. Time : From …….……... To ……………..

Zone : ……………………… Road :………………………………………..
Road Authority : RDA / PRDA / MC / PS / IRR
Chainage : ............................. RHS/LHS : …………………..

1) Availability
Description Number Remarks Description Yes(√ )or No Remarks
(X）

Labour Force Safety Arrangement安全安排

Engineers Safety Boards

T/O ' s Barricade Board
Supervisors Traffic Sign Board
Operators Traffic Cones
Drivers Lighting Devices
Labours Vehicle Guidance with Flag
Pipe Fitters Barigate Tape

Safety officers

Equipment Material Availability

Excavater/JCB Sand as bedding material
Tipper Approved surounding Material
Tractor ABC
Boom Truck Premix
Compactor CSS I & CRS I
Asphalt cutter Temporary Repair Pipes & Fittings <63mm

Asphalt concrete

2) Field Records
Under ground utility details or Fosils , Rocks , or other important objects ( Cross section)
Details of utilities

Water line Perimeter(mm) Dia (mm) Depth (mm) Pipe Material

Other Utilities Perimeter(mm) Dia (mm) Depth (mm) Pipe Material

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3) Tie measurement of the locations
Plan

Dimension of the pit

a/(m) b/(m) h/(m)

4) Photographs taken - Yes/No

5) Traffic Management & Safety - Satisfactory / Not Satisfactory

6) Any Damage was made in exiting utilities
Details & Remarks
………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………….

7) Backfilling & Reinstatements Details

Cross Section

Material Used

Material a/(m) b/(m) h/(m)

Other Comments:
………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………….

Prepared done by: UTE SETAPI ELLIPSE Approved by : NWS&DB

Signature :…………………………… Signature :…………………………………..
Name :…………………………… Name :…………………………………..
Designation :…………………………… Designation :…………………………………..
Date :…………………………… Date :…………………………………..

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