Scoping

Name

First NameLast Name

Date

DateHourMinutes

Asset / Int. Number

Manhole Reference Number

Map Number

Project

Street Name

Key Manhole (is this manhole key to future operations?)

Upstream or downstream

Manhole Gen Location

Location Details

Additional Location Details

Traffic Management

Traffic Management Details

Additional TM Details

Asset information

Road Width

m

Cover

Width x Breadth

Shaft Depth

mm

Shaft Width-x-Breadth

Overall depth

m

Condition of Cover

Amount of Jetting Required

Amount of silt/debris

Type of survey

(Normal, Sonar, Flow through)

Flow in pipe

%

Flow speed

Work shift required

Comments from scoping camera

Survey Comments

Manhole State

Pipe Diameter

If Other

Pipe Material

If Other

System Type

If Other

Manhole comments

Re-line / Patching - Can Manhole be accessed

General information for asset connected to this manhole (entire length of asset)

Additional asset information

Contact Details (provide details for works on private land)

Contact Name

Contact Number / email

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Aegion is the parent company of Aegion Coating Services, AllSafe Services, The Bayou Companies, Brinderson, Corrpro Companies, Fibrwrap Construction Services, Fyfe Co., Insituform Technologies, MTC, Schultz, Underground Solutions and United Pipeline Systems

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