Sewer Maintenance Workflow Checklist Form

Sewer Maintenance Workflow Checklist Form
Complete this checklist to document and verify each step of the sewer maintenance process.
Work Order Number
Maintenance Team Leader Name
First NameLast Name
Team Members Present
Date and Time of Maintenance
MonthDayYear
Date
Hour MinutesAM/PM Option
Sewer Maintenance Location Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Pre-Maintenance Site Assessment
Rows Yes No N/A
Access to site clear
Hazard signs posted
Confined space entry required
Weather conditions safe
Equipment Checklist (Check all that apply)
Other
Safety Protocols Followed
Rows Yes No N/A
Lockout/Tagout procedures
Ventilation established
Personal protective equipment worn
Gas levels tested
Maintenance Tasks Completed (Check all that apply)
Other
Observations/Issues Noted
Additional Comments or Recommendations
Supervisor Name
First NameLast Name
Supervisor Signature (Confirming completion and review)
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Rows	Yes	No	N/A
Access to site clear
Hazard signs posted
Confined space entry required
Weather conditions safe

Rows	Yes	No	N/A
Lockout/Tagout procedures
Ventilation established
Personal protective equipment worn
Gas levels tested