CityFibre Pole Inspection Template (BP)

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

City conducted:

• PN Number:

• Principle contractor:

• Sub contractor (if applicable):

• Please remember to provide photo evidence for all applicable questions

Pole Inspection

• Have whereabouts been submitted and are details (persons on site, date/time of work etc) consistent with what you have found at site?

  Yes

  No

  N/A

• Are you inspecting an Openreach or CityFibre pole?

  OpenReach

  CityFibre

• Please advise who owns the asset .

• What is the Pole ID?

• Has the engineer got the correct accreditations (NRWSA, SA001, SA7)?

  Yes

  No

  N/A

Pole Check/Test

• Have drop wire minimum height checks been completed?

  Yes

  No

  N/A

• Has the engineer checked the correct depth of installation?

  Yes

  No

  N/A

• Is there any sign of damage to the pole? (Damage caused by hedge trimming, vehicle damage, Vandalism etc.)

  No

  Yes

  N/A

• Is the pole in date to climb?

  Yes

  No

  N/A

• Can at least three quarters of the circumference of the pole be seen and tested?

  Yes

  No

  N/A

• D = Defective (Decay) DO NOT CLIMB
  SC= Shallow climbable SD= Shallow depth (THESE POLES SHOULD NOT BE CLIMBED)
  H + Z = Hazard near the pole, if an engineer can safely position their ladder in such a way to reduce the hazard then the pole can be climbed.

• Is there a D, SC, SD, H or Z tag?

  Yes

  No

  N/A

• Is there any decay or rot suspected on the pole?

  Yes

  No

  N/A

• Is there any bleeding apparent on the pole

  Yes

  No

  N/A

Pre-climb Set Up

• Is the site set up in accordance with Streetworks guidance (Red Book)?

  Yes

  No

  N/A

• Has consideration been given to passing MOPs and vehicles and an adequate exclusion/drop zone been put in place?

  Yes

  No

  N/A

• Has consideration been given to current and potential weather conditions?

  Yes

  No

  N/A

PPE

• Is PPE being worn correctly and appropriate for the works being conducted?

  Yes

  No

  N/A

Commencement of Climb

• Is the pole being accessed as per SA001?

  Yes

  No

  N/A

Bringing Tools and Equipment to Work Area

• Are tools and equipment secured to prevent drops?

  Yes

  No

  N/A

ASN Checks

• Has the equipment been fitted safely and securely in accordance with CF & OR specs?

  Yes

  No

  N/A

Good Practice & Sign Off

• Are there any exceptionally good safety behaviours or standards of work being exhibited?

  Yes

  No

  N/A

• Please give a description of the practice you have observed and would like recognised

• Sign Off

  Sign

• Auditor Signature

  Sign