Title Page
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Client / Site
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Conducted on
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Prepared by
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Site Type
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Personnel
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Site Status
Health & Safety
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JSA / Simpro
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JSA is up to standards
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Has all the hazards been identified?
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If no, what are the risk not identified:
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Complete PPE
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Proper use of PPE
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PPE (Personal Protective Equipment) Requests:
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Site Set-up
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Controls in Place
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Add media
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Fire Extinguisher
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First Aid kit
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MSDS/ SDS Sheets
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Hazardous Chemical Register
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Hazardous Chemical Container
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Electrical Register
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Ladder & Rack Inspection Register
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Harness / Pole Strap / Lanyard
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Fibre Sharps Container
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Clearvision Field pack (signed)
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CAT4 & Genny / Locator
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Volt detector w/ stud finder
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Enable Standards documents (soft / hard copy)
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Permits
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Permit type:
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Inspected by:
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Acknoledge by (lead tech)
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Acknowledge by (assistant tech)
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Health & Safety Non-Conformance
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Health and Safety Non-Conformance photos
Quality Assurance
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Consent Form (Signed)
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Fibre / Hybrid / Conduit Run
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FTP / BUDI installation
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FTP / BUDI Cable Management
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Add media
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ONT Installation
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ONT Cable Management
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Add media
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Concrete slot-cut (micro-cutting)
- Yes
- No
- N/A
- Standard
- Non-standard hard surface
- Non-standard soft trench
- ISB
- OSB
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Add media
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Trenching
- Yes - shallow trench (ISB)
- Yes
- N/A
- Non-standard
- Yes standard trench
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Shallow Trenching (300mm)
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Add media
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Reinstatement
- Yes
- No
- N/A
- Standard
- Non-standard hard surface
- Non-standard soft trench
- ISB
- OSB
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Add media
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All approved materials used
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Was the end-customer happy how the task was planned & completed?
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Notes
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Van / Trailer / Truck cleanliness
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Site cleanliness:
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Techs Presentation
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Add media
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Bottleneck Issues?
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Describe issues:
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Add media
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Inspected by:
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Acknowledged by (lead tech)
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Acknoledge by (assistant tech)
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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
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Pass or Fail
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Non-Conformance Details
