Title Page
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Customer Address
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Customer Number
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Conducted on
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Prepared by
SITE SET UP
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Site setup required? (Please add photos of barriers, signage, permit boards etc)
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Pole setup required? (Please add photos of set up including pre-climb label and pole markings)
JOB DETAILS
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Has the Job been Completed?
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Description of works completed?
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MST Number (Photo required)
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Port Number
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Light Reading (Photo Required)
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Overhead
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Provide photos below (tick boxes when photos have been attached):
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Over Head cable span (multiple if required)
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Bracket/Eyebolt
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External cabling at property (multiple if required)
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Fibre termination inside wall-box
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Cable coil
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Light Reading at property (Picture required)
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Additional Information or Pictures
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Underground
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Provide photos below (tick boxes when photos have been attached):
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View inside open chamber
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Works prior to reinstatement
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Reinstatement after works
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Duct customer end
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External cabling at property (multiple if required)
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External wall-box
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Fibre termination inside wall-box
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Cable coil
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Light reading at property (Picture required)
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Additional Information or Pictures
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Reason for failure (full details to be added to A55 if applicable) - add Pictures relevant to failure.
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Any Additional relevant information
