Agreed Customer Scope for Fibre Install

• Address

• Date

  Date

• Prepared by:

Customer / Job Details

• Name

Health, Safety and Environmental Issues

• Dogs on site?

  Yes

  No

  N/A

Special Consents Required

• Landlord consent required?

  Yes

  No

  N/A

• Right of way?

  Yes

  No

  N/A

• Multi dwelling unit?

  Yes

  No

  N/A

• Heritage site or Building?

  Yes

  No

  N/A

External Work

• What is the customer's preferred installation method?

  Select 1. Aerial fibre cable 2. Use existing duct 3. Surface mounted cable 4. Soft surface trenching 5. Drilling 6. Hard surface trenching

  • 1. Aerial fibre cable
  • 2. Use existing duct
  • 3. Surface mounted cable
  • 4. Soft surface trenching
  • 5. Drilling
  • 6. Hard surface trenching

• Chorus approval required

• Add photo and drawing of preferred method

  Media

• What is the customer's backup installation method?

  Select 1. Aerial fibre cable 2. Use existing duct 3. Surface mounted cable 4. Soft surface trenching 5. Drilling 6. Hard surface trenching

  • 1. Aerial fibre cable
  • 2. Use existing duct
  • 3. Surface mounted cable
  • 4. Soft surface trenching
  • 5. Drilling
  • 6. Hard surface trenching

• Chorus approval required

• Add photo and drawing of backup method

  Media

• Customer consent to build when not home?

  No

  Yes

• Location of ETP?

• ETP location photo

  Media

• Other requirements? I.e Traffic Management Plan, Arborist

  Select No Level 2 traffic management plan Arborist Obstruction plans required Other

  • No
  • Level 2 traffic management plan
  • Arborist
  • Obstruction plans required
  • Other

• What is required?

• Special instructions and notes

  Yes

  No

  N/A

External Work Consents - Boundary to ETP

• Hole excavation and trenching?

  Yes

  No

  N/A

• Removal of concrete/tiling/pavement?

  Yes

  No

  N/A

• Installation of pipe(s)?

  Yes

  No

  N/A

• Clean up: We will leave the property in a clean and tidy state on completion. This does not include reinstatement to the same condition.

Internal Work

• Location of ONT?

• ONT location Photo

  Media

• Underfloor access?

  Yes

  No

  N/A

• Ceiling access?

  Yes

  No

  N/A

• Special instructions and notes

  Yes

  No

  N/A

Internal Work Consents

• Drilling small holes and installation of hardware ?

  Yes

  No

  N/A

• Cutting holes in walls?

  Yes

  No

  N/A

• Exposed surface wiring?

  Yes

  No

  N/A

• Others?

  Yes

  No

  N/A

Additional Notes

• Notes

• Add labelled photos using the 'inote HD' app

  Media

Signed Consent

• I confirm that:
  - I have seen, read and understood this information and the end user terms and accept those terms; and
  - I agree to Chorus undertaking the installation works and method chosen at or on the property; and
  - I agree Chorus may share information it has gathered or holds about me with phone and broadband providers for the purpose of connecting my property to Chorus' network via fibre
  - If I am not the owner of the property, I understand that (i) I need to obtain the consent of the owner for the installation works, and (ii) the installation works won't proceed until I notify Chorus I have obtained consent of the owner for the installation works; and
  - I understand that there may be an impact on the operation of burglar and medical alarms, particularly monitored alarms. [Note: check with your alarm provider or telecommunications service provider]

• Optional - Permission to contact for marketing or research purposes?

  Yes

  No

  N/A

• End user signature:

  Sign