Chorus Colocation Pole Assesment V2- Unison

• Date audit undertaken

  Date

• This request is for a Unison connection

  Yes

  No

• Customer order #

• Street address of premise to be provisioned
  Address

• Connection types

  

• Type of connection requested

  Select Overhead to Overhead Underground to Overhead Overhead to underground Overhead to Overhead/Underground

  • Overhead to Overhead
  • Underground to Overhead
  • Overhead to underground
  • Overhead to Overhead/Underground

• First and Last name of person undertaking the audit

Pole Information

• Location of Pole
  Address

• Where is the pole located

  Berm/Roadside

  Inside property boundary

  Down a Right of Way

  Inside shared driveway

  Down a long driveway

• Pole type

  Softwood

  Hardwood

  Concrete

  Other

• State Pole type if identified above as "Other"

• Is it a special purpose pole?

  No

  Stub pole

  Brace Pole

  Pole with Jockey arms

• Approximate height in metres

• Approximate diameter (in cms)

• Ground restraint

  Concrete

  Grass

  Tarseal

  other

• Chorus pole tag colour

• Chorus tag number

• Power tag number

• Does the pole support spans of more than 100m or street lighting

  Yes

  No

• Number of copper service drop leads on pole

• Number of existing power service leads

• Number of existing fibre service drop leads

• Are there 4 or more existing service leads in the direction you wish to provision?

  Yes

  No

• Please take a photo of the relevant direction on the pole with 4 or more service leads

  Media

• State all materials to be attached to the pole?

  Select ADSS Drop cable Microduct Conduit Clamp Bracket FAT

  • ADSS Drop cable
  • Microduct
  • Conduit
  • Clamp
  • Bracket
  • FAT

• Please take at least 1 photo of the pole showing all connections on the pole. Annotate if possible

  Media

Qualifications

• Is the proposed installation to be installed in the Power plane or Telecommunications plane?

  Telecommunications plane

  Power plane

• The minimum qualification is line mechanic

• Has the line mechanic been inducted onto the network by Chorus?

  Yes

  No

• Do NOT carry out work on this asset

• Are you familiar with Unisons agreed design standards on Chorus Poles

  Yes

  No

• 

• Can All Service separation standards be maintained? Including Chorus Network Reserved attachment positioning - Existing or Future

  Yes

  No

• Chorus has reserved the right to deploy fibre in this area. If adequate separation cannot be maintained the connection will need to be undergrounded or the pole height increased.

• Can ground clearance standards be maintained

  Yes

  No

• Do ALL people undertaking this work have the required WTC/Qualifications to carry out work on these assets

  Yes

  No

• Do NOT carry out work on this asset

Pole testing

• Are you familiar with Chorus pole testing process

  Yes

  No

• Visual checks

  

• Hammer test

  

• Probe test

  

• Does the pole already have a "Caution do not climb" tag on it?

  Yes

  No

• Do NOT carry out work on this asset and call 0800 4 NETWORK Option 2 and ensure the reference # provided by Chorus in included on this request form.

• Visual Condition of Pole

  Good

  Average

  Poor

• Please take photos of any visible cracks showing length and depth or weaknesses in pole

  Media

• Please take photo showing hammer and probe testing has been undertaken

  Media

• Does the pole pass pole testing

  Yes

  No

• Faulty pole process

  

• Please enter fault job number

• Signature of person who undertook testing

  Sign

Photos

• Please provide photos of The entire pole in relation to nearby boundaries, any additional points of interest relating to the poles use, mark up the provisioning path along the Chorus poles

  Media