Scribd
Upload
4 views

CS2 Design review compliance statement

Uploaded by

tvquoc87
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
4 views

CS2 Design review compliance statement

Uploaded by

tvquoc87
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 3

An Auckland Council Organisation

Compliance statement Post: Watercare, Private Bag 94010, Auckland 2241


Email: [email protected]

CS2 – Design review Phone: (09) 442 2222


Website: www.watercare.co.nz

To be completed by the engineering professional who peer reviewed the design work done by others. This form needs
to be included as part of your engineering approval application to Auckland Council. However, if you are working on a
Watercare project, please send completed forms to the Watercare project manager.

Author’s details
First name/s Last name

Company

Business address:

Street number Street name

Suburb Postcode

Work phone ( ) Mobile

Email

Accreditation details
Academic qualification Engineering discipline

Competency accreditation

Accreditation body Registration number

Registered practice area*

*Attach proof from accreditation body

Parameters of this statement


Describe the design work certified by this statement
06-2017

continued >>>
Compliance statement CS2 – Design review 2

If in part, describe the overall project Not applicable

Site address:

Street number Street name

Suburb Postcode

Site legal description*

*Include the Lot number and DP number if available

Engaged by

Construction monitoring
Tick the recommended construction monitoring level below

ACENZ level CM2 CM3 CM4 CM5

OR

Watercare risk-based method**

**Attach a monitoring schedule, showing individual component criticality rating and monitoring competence requirements.

Supporting documents
Please list the design documents that have been reviewed and append the design review report.

Document name/number Date Version

DD / MM / YYYY

DD / MM / YYYY

DD / MM / YYYY

DD / MM / YYYY

DD / MM / YYYY

DD / MM / YYYY

DD / MM / YYYY

If you have more documents, you can attach a schedule which must include document dates and versions.
06-2017

continued >>>
Compliance statement CS2 – Design review 3

Declaration
I declare that:
1. I have due authority from my company to provide this compliance statement
2. The information in this statement is true and correct to the best of my knowledge
3. I have completed the design in accordance with Watercare engineering standards and codes of practices.
4. I understand that Watercare will rely on this statement to confirm compliance with the above requirements.
5. The proposed work covered by this statement is described in full in the design reports, specifications, the
drawings and other documents attached to this statement.
6. I understand that if I become aware of any change in circumstance or any reason why the information covered by
this statement might not be correct, I must notify Watercare as soon as possible.
7. I understand that information I provide on this form includes personal information covered by the Privacy Act 1993.
8. I authorise Watercare to collect, retain and use that personal information for the purpose of assessing my
suitability as an author of compliance statements. I also authorise Watercare to collect, retain and use (for that
same purpose) personal information about me from other sources available to Watercare including, but not
limited to, the professional or trade organisations, referees and any other persons or companies with whom I am
or have been associated. I understand that Watercare will handle such personal information in accordance with
its Privacy Statement located at: www.watercare.co.nz/about-watercare/about-this-site/privacy-statement

Author’s name Author’s


signature
Date DD / MM / YYYY

On behalf of:

Watercare office use


Received by

Yes Yes
Statement valid Insurance validation required
No No
06-2017

You might also like