Information

  • Service Order Number

  • Conducted on

Pole Information

  • Pole Asset Number

  • Asset Number Photo

  • Photo of full pole

  • Pole Address
  • Pole Tagged 'Do Not Climb'

  • Visual Inspection

  • Hammer & Probe Test

  • Any Issues with Pole head?

  • Distance between lowest power and NGA

  • Confirm distance here (eg: 600mm)

Tech Information

  • Issuer Name

  • Sign Here

  • Issuer Company

  • Parent Company

Tech Health & Safety

  • Which WTC's do you hold

  • What is your PPE rating?

  • What is the Minimum Distance between NGA and power?

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.