QES Management System
Issue Date: 01/07/2014
Pre-construction verification form
This form must be lodged by the consultant and submitted
at least seven days prior to construction starting
City West Water
Email designs@citywestwater.com.au
Service (please select)
Water supply
Recycled water
Sewerage
Development details
Location/estate name:
City West Water reference:
Developer:
Consultant:
Consultant nominated representative:
1 Documentation to be submitted (please select):
1.1 consultant’s risk based audit schedule in accordance with clause 3.1.7 of the City West Water’s Land Development Manual
1.2 project management plan
1.3 contractor’s inspection and test plan
1.4 Verification Attachment Sheet, if any of the items on this form are not applicable
1.5 current ‘Issued for Construction’ design plans
1.6 geotechnical report & project specific backfill specification.
2 Information
General
Starting date
Estimated completion date
Working hours
Personnel
Contractor
Ph:
Consultant’s key personnel
– construction auditor
Ph:
Contractor’s key personnel
– construction supervisor
Ph:
Licensed surveyor
Ph:
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QES Management System
Issue Date: 01/07/2014
Sub-contractors
Authorised pipelayer
Ph:
Maintenance hole builder
Ph:
Approved live sewer contractor
Ph:
Tapping under pressure – water contractor
Ph:
Boring contractor
Ph:
3 Consultant’s assurance
As the Consultant’s nominated representative responsible for the project management
of the development works detailed in the Development Deed, City West Water reference:
I verify that:
The project management of the development works will be conducted in accordance with the Development Deed and its referred documents
and standards.
Consultant’s nominated representative
Name:
Company position:
Signature:
Date:
Any changes to this form must be submitted to City West Water at least two days prior to changes taking place.
Important privacy notice
City West Water is a state owned company which provides retail water, sewerage and trade waste services to Melbourne’s central business
district, inner and western suburbs.
By completing this form you are providing personal information to City West Water for the primary purpose of City West Water providing you
with a water or sewerage supply. To read City West Water’s complete privacy statement, please visit citywestwater.com.au
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