Information
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PM No.
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Ready to Invoice?
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Notification No.
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Location # (Separate by comma if multiple)
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Division
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Address
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MAT
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Contractor
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Crew Foreman Name
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Field Inspector
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Construction Completed On
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QA Inspection Completed On
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Field Inspection Performed?
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Submission number
Quality Control Inspection - Field Only
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1. Is the scope of work 100% complete? If work is remaining, check "No" and list the items needing to be completed in Notes.
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2. Is the completed work free of quality issues? If quality issues are present, check "No" and list the issues in Notes.
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3. Is the job built per the OH/UG Standards? If the construction is not in compliance with the standards, check "No" and list the issues below.
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4. Are any changes to the original design reflected in the submitted as-builts, crew instructions, materials, joint pole forms, circuit map change sheets, etc. If the field conditions are not accurately reflected in the closeout package, check "No" and list the issues below.
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5. Has a Construction Completion Standard Checklist (CCSC) been submitted for every significant facility? Are the forms filled out completely and accurately? If there are forms missing or the information on a submitted form is incomplete/inaccurate, check "No" and list the issues below.
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Select OH and/or UG CCSC.
- OH CCSC
- UG CCSC
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Select OH CCSC Issue/Issues
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Select UG CCSC Issue/Issues
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6. Has all required permanent restoration been completed? (Examples: Concrete, Asphalt, Sunken Box or Pole Hole etc.)
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7. Add a minimum of 3 pictures of each location. (Bottom Half, Top Half, Whole Pole)
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Reviewer's Signature
Document Review
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1. Are any changes to the original design reflected in the submitted as-builts, crew instructions, materials, joint pole forms, circuit map change sheets, etc?
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2. Is the job built per the OH/UG Standards? If the construction is not in compliance with the standards, check "No" and list the issues below.
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3. Electric Equipment/Pole Information is complete?
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4. Crew Foreman Sign-Off is complete (this includes Actual Circuit Feet Installed and confirmation of what condition the job was left in (ex: Built as Designed, Redlined, Feedback Form Completed, etc.)?
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5. Electric Corrective (EC) Notification is complete (all applicable check boxes addressed, LAN ID or full name, signed and dated)?
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6. Joint Pole documentation is complete. Forms are redlined as applicable?
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7. Construction Drawings are complete. Drawings are redlined as applicable?
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8. Is the Circuit Map Change Sheet complete? Are changes redlined as necessary?
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9. Has a Construction Completion Standard Checklist (CCSC) been submitted for every significant facility? Are the forms filled out completely? If there are forms missing or the information on a submitted form is incomplete, check "No" and list the issues below.
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10. Color photos are included for every location on the job?
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Final Deliverable Review (Paperwork Only) - Total Number of Non-Conforming Items
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Reviewer's Signature
