Template

Reinstatement Blockage Checklist

by Kyan Snowden, from the Community

Use this checklist to document reinstatement works for blockage repairs. Capture site setup, permits, utilities marking, and hazard checks. Record excavation details with photos of initial dig, blockage, repair, sub base, sand and marker tape, and final surface (tarmac or verge). Enter measurements (length x width x depth) and coordinates (Eastings and Northings) to satisfy council requirements. Include bitumen use, reinstatement steps, site clearance, and completion time and date. Supports multiple blockages with repeatable sections.

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With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

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This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Civils Blockage Report
Use this civils blockage report template to capture essential details when ducts or chambers are obstructed on civil works. Record site address, permits, coordinates and What3Words, photos before excavation, open dig evidence, repair details, reinstatement type and dimensions, and proof of rope in both chambers. Log multiple blockages with separate sections, note causes, actions, and responsible parties, and collect names of operatives, dates, and signatures to support safe, compliant reinstatement and timely escalation.
by SML Office, from the Community
Downloads: 10+
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Template
GE Services Blockage SPO Evidence Form
Use this evidence form to document telecom blockage repairs for ducts or pole bends. Capture client and job references (PIA NOI, Siebel, GES), build area, PN and asset affected, location, and permit details. Record coordinates (eastings/northings), SLG setup, and whether the blockage involves a duct or pole bend. Attach required photos from pre-dig, excavation, repair, and reinstatement, showing split collars, secure ties every 10 cm, and connector bend. Log completion time and signatures for QA.
by Steve Linacre, from the Community
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Template
Blockage Repair Checklist
Use this telecom blockage repair form to capture risk assessments, pre-start and site setup photos, duct exposure and repair evidence, and HAUC-compliant reinstatement details. Record dig dimensions, surface types, grid references, and completion status, including roping, cabling, and backfill materials. Ensure jobs are documented with clear aspect photos and sign-off to meet safety and quality standards.
by Rod Davey, from the Community
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Template
Registration of Reinstatement Checklist
Use this registration of reinstatement checklist to record and verify reinstatement works after excavation or repair. Capture site details, work reference, location description, and dimensions including position, length, and width. Log whether reinstatement is permanent or temporary, record Easting and Northing coordinates, and attach photos for evidence. Add notes, assign actions, and collect name and signature for sign off to ensure compliance and traceability. Ideal for civil, road, and utilities teams managing backfill, surfacing, and final handover.
by Robert Janes, from the Community
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Reinstatement Blockage Checklist

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You might also like

Civils Blockage Report

GE Services Blockage SPO Evidence Form

Blockage Repair Checklist

Registration of Reinstatement Checklist

You might also like

Civils Blockage Report

GE Services Blockage SPO Evidence Form

Blockage Repair Checklist

Registration of Reinstatement Checklist