Title Page
-
Client / Site
-
Conducted on
-
Prepared by
-
Site Type
- SDU VPL
- SDU UCG
- MDU VPL
- MDU UCG
- MDU VPL Civil
- MDU UCG Civil
- MDU VPL Build
- MDU UCG Build
- Provisioning (Hamilton)
- Civil (Hamilton)
- Enable Provisioning
- Enable Civil
- Enable ROW
-
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)
- Yes
- No
- N/A
-
MSDS/ SDS Sheets
-
Ask Crew to secure MSDS Sheets for all chemicals in their vehicle
-
Hazardous Chemical Register
-
Hazardous Chemical Container
- Yes
- No
- N/A
- Standard
- Non-standard hard surface
- Non-standard soft trench
- ISB
-
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
- Yes
- No
- N/A
- Standard
- Non-standard hard surface
- Non-standard soft trench
- ISB
-
Permits
-
What type of permit is present at site
- Ground Disturbance Permit
- Excavation Drill Permit
- Working at heights Permit
- Confined space Permit
-
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
- Yes
- No
- N/A
- Standard
- Non-standard hard surface
- Non-standard soft trench
- ISB
-
Add media
-
Surface mounting / Fence line
- Yes - shallow trench (ISB)
- Yes
- N/A
- Non-standard
- Yes standard trench
-
Add media
-
Draw tapes replaced?
-
Reinstatement
- Yes
- No
- N/A
- Standard
- Non-standard hard surface
- Non-standard soft trench
- ISB
-
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?
- Yes
- No
- N/A
- Standard
- Non-standard hard surface
- Non-standard soft trench
- ISB
-
Describe issues:
-
Add media
-
Audit Rating (out of 20)
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
- 20
-
Pass or Fail
-
Inspected by:
-
Acknowledged by (lead tech)
-
Acknoledge by (assistant tech)
-
Non-Conformance details
