Title Page

  • Document No.

  • Line

  • Station

  • Area at Station

  • Station

  • Station

  • Station

  • Station

  • Conducted on

  • Prepared by

    Pole
  • Take photo of Pole

  • Location of pole
  • Add GW SAP Equipment number if assigned (on pole sticker)

  • What type of pole is it?

  • What is the condition of the pole?

  • Any extra notes?

  • How many light fittings on pole?

  • Fitting 1 - Type

  • If other type please describe

  • Condition Rating

  • Photo of fitting

  • Any other notes

  • Fitting 1 - Type

  • If other type please describe

  • Condition Rating

  • Photo of fitting

  • Any other notes

  • Fitting 2 - Type

  • If other type please describe

  • Condition Rating

  • Photo of fitting

  • Any other notes

  • Fitting 1 - Type (Multiple Selection)

  • If other type please describe

  • Condition Rating

  • Photo of fitting

  • Any other notes

  • Fitting 2 - Type

  • If other type please describe

  • Condition rating

  • Photo of fitting

  • Any other notes

  • Fitting 3 - Type

  • If other type please describe

  • Condition Rating

  • Photo of fitting

  • Any other notes

  • Fitting 1 - Type

  • If other type please describe

  • Condition Rating

  • Photo of fitting

  • Any other notes

  • Fitting 2 - Type

  • If other please describe (Free text)

  • Condition Rating

  • Photo of fitting

  • Any other notes

  • Fitting 3 - Type

  • If other please describe (Free text)

  • Condition rating

  • Photo of fitting

  • Any other notes

  • Fitting 4 - Type

  • If other please describe (Free text)

  • Condition rating

  • Photo of fitting

  • Any other notes

  • Non Pole Mounted Lights
  • Describe where is light mounted?

  • Location
  • Take photo of light fitting

  • Type of fitting - Multiple Selection

  • If other type please describe

  • Condition Rating

  • Any extra notes?

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