• Address

  • Customer Name

Vital Information

  • Are there any Dogs on Site?

  • Is Landlord Consent Required?

Audit Information

  • Date

  • Prepared by:

External Methodology

External Work

ETP Location

  • Location of ETP?

  • ETP location photo

Preferred Installation Methodology

  • What is the customer's preferred installation method?

  • Chorus approval required

  • Installation Methodology

  • Add photo and drawing of preferred method

Other Requirements - If Required

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

  • What is required?

  • Special instructions and notes

Internal Methodology

Internal Work

  • Location of ONT?

  • ONT location Photo

Internal Cabling Questions

  • Underfloor access?

  • Ceiling access?

  • Special instructions and notes - If Required


Special Property Consents Required

  • Right of way?

  • Multi dwelling unit?

  • Heritage site or Building?

External Work Consents - Boundary to ETP

  • Hole excavation and trenching?

  • Removal of concrete/tiling/pavement?

  • Installation of pipe(s)?

  • 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 Consents

  • Drilling small holes and installation of hardware ?

  • Cutting holes in walls?

  • Exposed surface wiring?

  • Others?

Additional Notes - If Required

  • Notes

  • Add labelled photos

Agreement and Signature

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
    - 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]

  • End user signature:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.