Template

E&I Site Survey Form Template (11/23)

by Shaun Bennett, from the Community

Use this Electrical and Instrumentation site survey checklist to document proposed works, site access and condition, CDM considerations, and key hazards. Capture building construction, access constraints, sizes, and any required works. Record electrical supply characteristics, protection, earthing, generators, and items to replace, with photos. Audit telemetry and RTU systems, HMI screens, third-party inputs, panels, and communications, noting isolations and shared signals. Verify field equipment details, certifications, and cable routes, and assess civil works needs, duct capacity, and welfare arrangements. Ideal for gas utility sites and shared installations.

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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
Electrical and Instrumentation Site Survey Form
This Electrical and Instrumentation site survey form helps teams assess energy and utility sites before project works. Capture location, access and site condition photos, note proposed works and any ongoing activity, and document hazards and traffic management under CDM. Record building construction, access restrictions, dimensions and asbestos information, plus any building works required. Detail electrical supply characteristics, protection, earthing and equipment to replace, including generators and transformers. Cover telemetry and control systems such as RTU and HMI, shared signals and panel space. List field equipment with certification and condition, and evaluate civil works, ducts, cable routes and welfare needs. Attach comprehensive photos and notes to support planning and safe execution.
by Shaun Bennett, from the Community
Downloads: 0
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Template
Push Pit Monthly Inspection
This Electrical and Instrumentation site survey form helps teams assess energy and utility sites before project works. Capture location, access and site condition photos, note proposed works and any ongoing activity, and document hazards and traffic management under CDM. Record building construction, access restrictions, dimensions and asbestos information, plus any building works required. Detail electrical supply characteristics, protection, earthing and equipment to replace, including generators and transformers. Cover telemetry and control systems such as RTU and HMI, shared signals and panel space. List field equipment with certification and condition, and evaluate civil works, ducts, cable routes and welfare needs. Attach comprehensive photos and notes to support planning and safe execution.
by Shaun Bennett, from the Community
Downloads: 0
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Template
E&I Site Survey Form
This E&I site survey form helps teams capture a complete overview of site conditions and requirements for electrical and instrumentation works. Document access and site condition, CDM and traffic management considerations, and key building details including construction, access, dimensions, doors, and asbestos status. Record electrical supply characteristics, protection, earthing, generators, transformers, and items to replace with supporting photos. Audit telemetry and RTU systems, shared signals and equipment, panel sizes, PSU, and space for upgrades. Log field instrumentation and valves with EX certifications and decide on keep or replace. Plan site works such as new buildings, civil works, cable routing, pits, ducts, and segregation. Add photos, measurements, and notes to support accurate planning and safe execution.
by Shaun Bennett, from the Community
Downloads: 10+
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Template
E&I Site Survey Form (11/23)
This E&I Site Survey Form helps teams document site access and condition, landlord and OAD status, hazards, traffic management and welfare needs. Capture building construction, access restrictions, dimensions, doors, and asbestos reports. Record electrical supply characteristics, earthing, distribution gear, transformers, generators, and items to replace, with photo evidence. Survey telemetry systems including RTUs, HMIs, barriers, panels, third-party inputs, GRSC or satellite units, and shared signals. List field equipment with EX certifications and isolation details. Plan civil works, cable routes, ducts, pits, and building requirements, ensuring segregation and safe access, with comprehensive notes and photos.
by Shaun Bennett, from the Community
Downloads: 0
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E&I Site Survey Form Template (11/23)

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