Title Page

  • Client / Site

  • Conducted on

  • Prepared by

  • Site Type

  • Personnel

Health & Safety

  • JSA / Take 5 / SiteTRAX / is Completed

  • JSA / Take 5 / SiteTRAX / is up to standards

  • What are the risk not identified or controlled:

  • Crew has Complete PPE (fit for purpose)

  • Proper use of PPE

  • PPE (Personal Protective Equipment) Requests:

  • What are the requested PPE?

  • Site Set-up

  • Controls in Place

  • Add media

  • Fire Extinguisher

  • First Aid kit

  • Any ground Disturbance on site?

  • What type of site?

  • Has the Ground Disturbance / Excavation & Drilling (ISB and / OSB) Permit been completed?

  • Stop Works and ask crew to complete GDP / EDP (ISB/OSB)

  • TMP (Traffic Management Plan)

  • MSDS/ SDS Sheets

  • Ask Crew to secure MSDS Sheets for all chemicals in their vehicle

  • Hazardous Chemical Register

  • Hazardous Chemical Container

  • Electrical Register

  • Ladder & Rack Inspection Register

  • Harness / Pole Strap / Lanyard

  • Fibre Sharps Container

  • Ask Crew to get one from the office or label a sealed bottle as a sharps container

  • UCG-SMnz / VPL SWMS / Clearvision Field Pack

  • CAT4 & Genny / 3rd Dynatel 2273 / Volt detector

  • Volt detector w/ stud finder

  • Chorus NGA Provisioning Task Handbook & MDU Provisioning Task Handbook / Enable standards books / Tech manual

  • Permits

  • What type of permit is present at site

  • Permit Issuer:

  • Crew On-site Behaviour

  • Comments on behavior and Site Observation notes

  • Inspected by:

  • Acknoledge by (lead tech)

  • Acknowledge by (assistant tech)

  • Non-Conformance details

Quality Assurance

  • Consent Form (Signed) / Given by all owners on a ROW

  • Fibre / Hybrid / Conduit Run

  • FTP / BUDI installation

  • FTP / BUDI Cable Management

  • Add media

  • ONT Installation

  • ONT Cable Management

  • Hybrid / Composite Cable connected to legacy wiring (Integration)

  • Add media

  • Aerial Lead at Premise

  • Aerial Lead at Pole

  • Aerial Lead at Multiple Spans

  • Add media

  • Concrete slot-cut (micro-cutting) and/or slot-trench (shallow trench) 200/300mm

  • Add media

  • Surface mounting / Fence line

  • Add media

  • Draw tapes replaced?

  • Reinstatement

  • Add media

  • Only Approved Materials Used

  • ETA / SiteTRAX / Simpro details all correct?

  • Was the end-customer happy how the task was planned & completed?

  • Van / Trailer / Truck cleanliness

  • Site cleanliness:

  • Techs Presentation

  • Add media

  • Bottleneck Issues?

  • Describe issues:

  • Add media

  • Audit Rating (out of 20)

  • Pass or Fail

  • Inspected by:

  • Acknowledged by (lead tech)

  • Acknoledge by (assistant tech)

  • Non-Conformance details

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.