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.
Untitled Page
Crew Infirmation
-
Supervisor
- Tristan Gazzea
- Lindsey Leavoy
- Travis Etheredge
- Brad Tyler
- Scott Parrish
- Randy Carlton
- Oliver Le
- Tony Lopez
- Justin Vollmer
- Fred Dueker
- Austin Erickson
- Travis Trosclair
- Mike Eason
- Devin Landry
- Jon Sedillo
- Thomas Savoie
-
-
Crew Leader
- Tristan Gazzea
- Lindsey Leavoy
- Travis Etheredge
- Brad Tyler
- Scott Parrish
- Randy Carlton
- Oliver Le
- Tony Lopez
- Justin Vollmer
- Fred Dueker
- Austin Erickson
- Travis Trosclair
- Mike Eason
- Devin Landry
- Jon Sedillo
- Thomas Savoie
-
Crew Member 2
- Tristan Gazzea
- Lindsey Leavoy
- Travis Etheredge
- Brad Tyler
- Scott Parrish
- Randy Carlton
- Oliver Le
- Tony Lopez
- Justin Vollmer
- Fred Dueker
- Austin Erickson
- Travis Trosclair
- Mike Eason
- Devin Landry
- Jon Sedillo
- Thomas Savoie
-
Crew Member 3
- Randy Carlton
- Tristan Gazzea
- Lindsey Leavoy
- Scotty Parrish
- Brad Tyler
- John Foster
- Fred Dueker
- Steve Dull
- Daniel Ballard
- Jody Matlock
- Adam Sinks
- Layne Dossey
- Seth Mooney
- Dale Erickson
-
Crew Member 4
- Randy Carlton
- Tristan Gazzea
- Lindsey Leavoy
- Scotty Parrish
- Brad Tyler
- John Foster
- Fred Dueker
- Steve Dull
- Daniel Ballard
- Jody Matlock
- Adam Sinks
- Layne Dossey
- Seth Mooney
- Dale Erickson
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
- Butt Splice
- Ring Tap Splice
- Fiber Turn
- Testing
- FDT
- MST
- NED-MST
- Macro Site Tower
- CMOD Splice
- Case re-entry
-
Description of Work Completed Today / Fibers spliced how many burns? Ribbon or singles? (should match the matrix!!)
-
HH or MN Location:
-
Permit Number:
Commscope
-
Type of Case:<br>
-
CommScope 24F
- Butt Splice
- Ring Tap Splice
- Fiber Turn
- Testing
- FDT
- MST
- NED-MST
- Macro Site Tower
- CMOD Splice
- Case re-entry
-
CommScope 72S
-
Type of trays used and how many:
-
MST/FDT Type:
- 4 Port FDT
- 8 Port FDT
- 12 Port FDT
- 6 Port MST
- Ghost MST
-
MST/FDT Drop Footage
Cable A Information
-
Cable ID
-
Direction
-
Enclosure Footage Marker
-
Pipe Footage Marker
-
PID Number
Cable B Information
-
Cable ID
-
Direction
-
Enclosure Footage Number
-
Entry/ Pipe Footage Marker
-
PID Number
Cable C Information
-
Cable ID
-
Direction
-
Enclosure Footage Number
-
Entry/ Pipe Footage Marker
-
PID Number
Cable D Information
-
Cable ID
-
Direction
-
Enclosure Footage Number
-
Entry/ Pipe Footage Marker
-
PID Number
Photos
-
Pictures of Rack RU, Panel front and back, site after work completed
-
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
-
NOC Release Time / Time of hands off
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
