Title Page
-
Customer
-
PSA/Work Order Number
-
Work Date and Start Time
-
Client / Site
-
Location.. Please drop pin at work location and enter site address if any.
Crew Infirmation
-
Supervisor
- Randy Carlton
- Steve Dull
- Bruce Bennett
- Chris Gambill
- Nick Vanlieshout
- Joel Bakken
- Landen Presfield
- Zack Stout
-
Crew Leader
- Randy Carlton
- Steve Dull
- Bruce Bennett
- Chris Gambill
- Nick Vanlieshout
- Joel Bakken
- Landen Presfield
- Zack Stout
-
Crew Member 1
- Randy Carlton
- Steve Dull
- Bruce Bennett
- Chris Gambill
- Nick Vanlieshout
- Joel Bakken
- Landen Presfield
- Zack Stout
-
Crew Member 2
- Randy Carlton
- Steve Dull
- Bruce Bennett
- Chris Gambill
- Nick Vanlieshout
- Joel Bakken
- Landen Presfield
- Zack Stout
-
Crew Member 3
- Randy Carlton
- Steve Dull
- Bruce Bennett
- Chris Gambill
- Nick Vanlieshout
- Joel Bakken
- Landen Presfield
- Zack Stout
-
Crew Member 4
- Randy Carlton
- Steve Dull
- Bruce Bennett
- Chris Gambill
- Nick Vanlieshout
- Joel Bakken
- Landen Presfield
- Zack Stout
Work Completed.
-
Type of work completed?
- Splicing
- Macro Corning 72 ct. Panel
- ISP Cable Installation
- Case Re Entry
- MISC
- Testing
- Troubleshooting
- Panel Installation
-
Type of Splice
- Macro 72ct Panel Splice
- Butt Splice
- Ring Tap Splice
- Fiber Turn
- Testing
- MF02 Butt
-
Description of Work Completed Today
Commscope
-
Case used:
-
Commscope 24F
-
Commscope 72S
-
Type of trays used and how many:
Cable A Information
-
Cable ID
-
Direction
-
Enclosure Footage Marker
-
Pipe Footage Marker
Cable B Information
-
Cable ID
-
Direction
-
Enclosure Footage Number
-
Entry/ Pipe Footage Marker
Cable C Information
-
Cable ID
-
Direction
-
Enclosure Footage Number
-
Entry/ Pipe Footage Marker
Cable D Information
-
Cable ID
-
Direction
-
Enclosure Footage Number
-
Entry/ Pipe Footage Marker
Photos
-
Picture of Slack Basket
-
Picture tray 1
-
Picture tray 2
-
Picture tray 3
-
Picture tray 4
-
Picture tray 5
-
Picture of Case Closed
-
Picture of plugs and gel pack
-
Picture of cable tags
-
Picture of case in the hole
-
Picture of hole closed
Complete Date and Time
-
Hands Off Dat and Time
-
NOC Release Time
-
Released By
Pre-Task Checklist
Weather
-
Weather Conditions
-
Temp
-
Additional Steps Taken For Weather Conditions
Site Setup Checklist
-
Required PPE?
-
Signs and Cones Placed
-
Wheels Chocked?
-
Customer Notification Completed?
-
Stretching/Warmup Completed?
Recognized Hazards (Check all that apply)
-
Chemicals
-
Pedestrian/Vehicle Traffic
-
Job Access
-
Co Vehicle Placement
-
Struck By’s
-
Pinch Points
-
Slips Trips and Falls
-
Excessive Noise
-
Eye Injury
Hazard Protection
-
Hearing Protection
-
MSDS Present
-
Equipment Inspection Completed
-
Flagged or Traffic Control Needed
Pre-Task Review
-
Discuss Yesterday’s Incidents
-
Site Safety Orientation Complete
-
Job Scope Understood
-
Good Catch Documented
-
Site Safety Assessment Completed
-
Additional Comments
