• Central Office Name

  • Application ID

  • SL job#

  • Conducted on

  • Location
  • Prepared by

OSPE Contact

  • Name

  • Phone Number(s)

Relay Rack or Proposed Relay Rack Location

  • Rack #

  • Picture of Existing Rack or Proposed Location of Rack

Pre-Term Cable 1

  • Count:

  • Length:

Pre-Term Cable 2

  • Count:

  • Length:


  • Picture:

Route 1 MMP

  • Scope of Work:

  • Collector Shot of Route 1

  • AT&T MH to SL HH

Route 2 MMP

  • Scope of Work:

  • Collector Shot of Route 2

  • AT&T MH to SL HH

Sign Off

  • Operator's signature

  • OSPE's signature

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.