Page 1: Initial questions

  • Build Area & DN (eg ILK-1-DN106)

  • A55 Type

  • PIANOI Number

  • DSR (Found on Vitruvi)

  • Full address including postcode

  • Name of on site person

  • Contact number of on site person

  • Date A55 complete

  • Local authority

Page 2: Main checklist

  • What is the A55 for?

  • What is the overhead issue?

  • Have you contacted poling help desk?

  • Is there an alternative route?

  • Give a brief description of what is required

  • What equipment is being added to the pole including dimensions (H, L, D)

  • Provide photographic evidence as set out in network adjustments guide

  • DP number

  • Existing pole size and class

  • Total existing wires on pole

  • Forecast total of CP wires to be added

  • Is this a side loaded pole?

  • Is this pole on private property?

Pole top consolidation

  • Have you contacted poling help desk?

  • Is there an alternative route?

  • Give a brief description of what is required

  • What equipment is being added to the pole including dimensions (H, L, D)

  • Provide photographic evidence as set out in network adjustments guide

  • DP number

  • Existing pole size and class

  • Total existing wires on pole

  • Forecast total of CP wires to be added

  • Is this a side loaded pole?

  • Is this pole on private property?

  • what is the A55 for?

  • Brief description on works required and why

  • Where is the chamber?

  • what is the current chamber type? (minimum of 4 pictures required)

  • what type of chamber is required

  • Surface type

  • Is this private property?

  • Is traffic management required?

  • Number of bores

  • Brief description of works required

  • Location of chamber 1 (X & Y) (minimum of 4 pictures required)

  • Photo of chamber 1 and bore with 25mm rod marked

  • Number of cables in bore

  • Distance to blockage (m)

  • Location of chamber 2 (X & Y) (minimum of 4 pictures required)

  • Photo of chamber 2 and bore with 25mm rod marked

  • Number of cables in bore

  • Distance to blockage (m)

  • Location of blockage ( X&Y )

  • Photo of blockage location marked with X with point of reference for location

  • Are there multiple blockages

  • Distance of untested duct between blockages (m)

  • Location of second blockage (X & Y)

  • Brief description of works required

  • What type of chamber is required?

  • What is the surface type?

  • Location of works (X & Y) (minimum of 4 pictures required)

  • Photo of location marked with X with point of reference

  • Number of ducts to enter chamber

  • Duct section number

  • Distance to Chamber 1

  • Distance to chamber 2

  • Is traffic management required?

  • Brief description of work required

  • Location of chamber 1 (X & Y) (minimum of 4 pictures required)

  • Photo of bore that requires additional capacity marked up

  • Are there any cables that may be recovered?

  • Location of chamber 2 (X & Y ) (minimum of 4 pictures required)

  • Photo of bore that requires additional capacity marked up

  • Are there any cables that may be recovered?

  • Duct section number

  • Brief description of works required

  • Location of chamber (X & Y) (minimum of 4 pictures required)

  • Type of chamber

  • Evidence of damage photos of chamber with lid on and internally including reference point

  • duct section number

  • Additional duct section number (s)

  • OR portal screen shot/ other image of location

  • 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.