Title Page

  • Client / Site

  • Conducted on

  • Prepared by

  • Site Type

  • Personnel

  • Site Status

Health & Safety

  • JSA / Simpro

  • JSA is up to standards

  • Has all the hazards been identified?

  • If no, what are the risk not identified:

  • Complete PPE

  • Proper use of PPE

  • PPE (Personal Protective Equipment) Requests:

  • Site Set-up

  • Controls in Place

  • Add media

  • Fire Extinguisher

  • First Aid kit

  • MSDS/ SDS Sheets

  • Hazardous Chemical Register

  • Hazardous Chemical Container

  • Electrical Register

  • Ladder & Rack Inspection Register

  • Harness / Pole Strap / Lanyard

  • Fibre Sharps Container

  • Clearvision Field pack (signed)

  • CAT4 & Genny / Locator

  • Volt detector w/ stud finder

  • Enable Standards documents (soft / hard copy)

  • Permits

  • Permit type:

  • Inspected by:

  • Acknoledge by (lead tech)

  • Acknowledge by (assistant tech)

  • Health & Safety Non-Conformance

  • Health and Safety Non-Conformance photos

Quality Assurance

  • Consent Form (Signed)

  • Fibre / Hybrid / Conduit Run

  • FTP / BUDI installation

  • FTP / BUDI Cable Management

  • Add media

  • ONT Installation

  • ONT Cable Management

  • Add media

  • Concrete slot-cut (micro-cutting)

  • Add media

  • Trenching

  • Shallow Trenching (300mm)

  • Add media

  • Reinstatement

  • Add media

  • All approved materials used

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

  • Notes

  • Van / Trailer / Truck cleanliness

  • Site cleanliness:

  • Techs Presentation

  • Add media

  • Bottleneck Issues?

  • Describe issues:

  • Add media

  • Inspected by:

  • Acknowledged by (lead tech)

  • Acknoledge by (assistant tech)

  • Audit Rating (out of 20)

  • Pass or Fail

  • 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.