Title Page

  • Company Name

  • Prepared by

  • LOC ID

  • SAM ID

  • Address

  • Locational
  • Date Conducted On

Initial Tap Findings

  • Tap Before Photo

  • Tap Reading Photo

  • High Frequency 743 MHz Tap Reading

  • Tap After Photo

  • Was Professional Traffic Control required on site (ZZ-2c)?

  • Sequence Number

  • Have you provided your Traffic Control Quote to your Team Manager?

  • Traffic Control Photos

  • Was a second person required on site for safety reasons (ZZ-1a1)?

  • How many hours were required (ZZ-1a1)?

  • Sequence Number

  • Type of Installation

Lead-in construction

  • Lead-in construction type

Underground Lead-in Details

  • Lead-In Length

  • Your Lead-in Length has exceeded 40m please ensure RG11 is installed.

  • Cable Type

  • What type of Lead-in was required on site?

  • Lead-in Area Before

  • Lead-in Work During

  • Lead-in After

  • Was there more than 20m of Trenching in OTR inside the customers property?

  • Extra distance over 20m (MM-6b1) per metre

  • Was there more than 2 metres of trenching in OTR required from the property boundary to the Network pit?

  • Extra distance over 2m (MM-6b2) per metre

  • Was there any Non-Trenching Methods used?

  • Was there any Rock

  • How many metres of Trenching in rock (FF-9c1) per m

  • Rock Photos

  • Sequence Number

  • Sequence Number

  • Groundomat Photo

  • Groundomat Distance Photo

  • How many metres of Groundomat in OTR (FF-12f1)

  • Establishment Charge (FF-12g2)

  • Sequence Number

  • Boring Photo

  • Boring Distance Photo

  • How many metres of Boring in OTR (FF-12a2)

  • Establishment Charge (FF-12g1)

  • Was there any Breakout & Reinstatement

  • Breakout Details

  • Breakout photos

  • Breakout Qty per square metre (FF-18a)

  • Breakout photos

  • Breakout Qty per square metre (FF-18b)

  • Breakout photos

  • Breakout Qty per square metre (FF-18c)

  • Reinstatement Types

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c3)

  • Reinstatement Detail

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b3)

  • Did you provide a conduit entry into an Asbestos pit (FF-4c)

  • Asbestos Photos

  • Was a pit required to be installed over existing conduit (FF-2b1)?

  • Sequence Number

  • Was P50 trenching required on site?

  • Sequence Number

  • How many metres of P50 trenching was required on site (FF-9a1)?

  • Was a new pit required to be installed (FF-1b1)?

  • Was There Any Blockages?

  • Type of Blockage

  • How many Buried Pits located (FF-15)?

  • Buried Pit before

  • Buried Pit After

  • How Many High Pressure Flushes (EE-14f)?

  • Spit water flush photo

  • How Many Low Pressure Flushes (EE-14g)?

  • Low pressure flush photo

  • How many Network blockages fixed (EE-14a1)?

  • Blockage Before

  • Blockage Repaired

  • Blockage Area After

  • Sequence Number

  • Was there any E/O

  • E/O Length EE14c1

  • Extra Length per metre (EE-14c1)

  • Additional length photo

  • E/O Depth EE14E1

  • Extra Depth per 500mm (EE-14e1)

  • Additional depth photo

  • Was there any Breakout & Reinstatement

  • Breakout Details

  • Breakout photos

  • Breakout Qty per square metre (FF-18a)

  • Breakout photos

  • Breakout Qty per square metre (FF-18b)

  • Breakout photos

  • Breakout Qty per square metre (FF-18c)

  • Reinstatement Types

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c3)

  • Reinstatement Detail

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b3)

  • Was Lead-in over 40m?

  • Extra distance over 40m (DD-5a7) per metre

  • Was There Any Blockages?

  • Type of Blockage

  • How many Buried Pits located (FF-15)?

  • Buried Pit before

  • Buried Pit After

  • How Many High Pressure Flushes (EE-14f)?

  • Spit water flush photo

  • How Many Low Pressure Flushed (EE-14g)?

  • Low pressure photo

  • How Many (MM-8a1)?

  • Sequence Number

  • Blockage Before Photo

  • Blockage Repair Photo

  • Blockage Area After Photo

  • Was there any Breakout & Reinstatement

  • Breakout Details

  • Breakout photos

  • Breakout Qty per square metre (FF-18a)

  • Breakout photos

  • Breakout Qty per square metre (FF-18b)

  • Breakout photos

  • Breakout Qty per square metre (FF-18c)

  • Reinstatement Types

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c3)

  • Reinstatement Detail

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b3)

  • How Many Y Joiners installed (MM-8a2)?

  • Sequence Number

  • Before Photo

  • Y Joiner Installed

  • Area After Photo

  • Was there additional metres above 2m required as part of a LIC extension (MM-6b1)?

  • How many metres above 2m were required (MM-6b1)?

  • Was there any Breakout & Reinstatement

  • Breakout Details

  • Breakout photos

  • Breakout Qty per square metre (FF-18a)

  • Breakout photos

  • Breakout Qty per square metre (FF-18b)

  • Breakout photos

  • Breakout Qty per square metre (FF-18c)

  • Reinstatement Types

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c3)

  • Reinstatement Detail

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b3)

  • How many Network blockages fixed (EE-14a1)?

  • Sequence Number

  • Blockage Before

  • Blockage Repaired

  • Blockage Area After

  • Was there any E/O

  • E/O Length EE14c1

  • Extra Length per metre (EE-14c1)

  • Additional length photo

  • E/O Depth EE14E1

  • Extra Depth per 500mm (EE-14e1)

  • Additional depth photo

  • Was there any Breakout & Reinstatement

  • Breakout Details

  • Breakout photos

  • Breakout Qty per square metre (FF-18a)

  • Breakout photos

  • Breakout Qty per square metre (FF-18b)

  • Breakout photos

  • Breakout Qty per square metre (FF-18c)

  • Reinstatement Types

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c3)

  • Reinstatement Detail

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b3)

PCD Testing and Final Photos

  • PCD installed

  • After photo open

  • PCD installed in an accessible area

  • PCD Strength Photo

  • High Frequency 743 MHz PCD Reading

Aerial Lead-In Details

  • Lead-In Length

  • Your Lead-in Length has exceeded 40m please ensure RG11 is installed.

  • Cable Type

  • Lead-In Photo

  • Was Additional Span Required

  • Was there E/O installation of new coaxial drop in-span required (HFC-9a2)?

  • In-span coaxial drop Photo

  • Was there E/O for additional spans of aerial drop HFC-9a3?

  • How Many additional spans were required (HFC-9a3)

  • Additional Span Photos

  • New House Riser Installed?

  • Riser Type Installed?

  • Fascia Riser Photo

  • New Pole Riser Installed? (CC-2c2)

  • Was drop cable installed through existing riser (DD-5a9)

  • Riser Photo

  • Was it over 2m in length FF9a1

  • Additional m over 2m (FF-9a1)

  • Was there any Breakout & Reinstatement

  • Breakout Details

  • Breakout photos

  • Breakout Qty per square metre (FF-18a)

  • Breakout photos

  • Breakout Qty per square metre (FF-18b)

  • Breakout photos

  • Breakout Qty per square metre (FF-18c)

  • Reinstatement Types

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c3)

  • Reinstatement Detail

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b3)

  • Did you provide a conduit entry into an Asbestos pit (FF-4c)

  • Asbestos Photos

  • Bandit Strapping CC2f each band

  • Bandit Strapping Photos

  • How many bandit straps installed (CC-2f)?

  • Was There Any Blockages?

  • Type of Blockage

  • How many Buried Pits located (FF-15)?

  • Buried Pit before

  • Buried Pit After

  • How Many High Pressure Flushes (EE-14f)?

  • Spit water flush photo

  • How Many Low Pressure Flushes (EE-14g)?

  • Low pressure flush photo

  • How many Network blockages fixed (EE-14a1)?

  • Sequence Number

  • Blockage Before

  • Blockage Repaired

  • Blockage Area After

  • Was there any E/O

  • E/O Length EE14c1

  • Extra Length per metre (EE-14c1)

  • Additional length photo

  • E/O Depth EE14E1

  • Extra Depth per 500mm (EE-14e1)

  • Additional depth photo

  • Was there any Breakout & Reinstatement

  • Breakout Details

  • Breakout photos

  • Breakout Qty per square metre (FF-18a)

  • Breakout photos

  • Breakout Qty per square metre (FF-18b)

  • Breakout photos

  • Breakout Qty per square metre (FF-18c)

  • Reinstatement Types

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c3)

  • Reinstatement Detail

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b3)

PCD Testing and Final Photos

  • PCD installed

  • After photo open

  • PCD installed in an accessible area

  • PCD Strength Photo

  • High Frequency 743 MHz PCD Reading

Lead-in construction

  • Lead-in construction type

Underground Lead-in Details

  • Lead-In Length

  • Your Lead-in Length has exceeded 40m please ensure RG11 is installed.

  • Cable Type

  • What type of Lead-in was required on site?

  • Lead-in Area Before

  • Lead-in Work During

  • Lead-in After

  • Was there more than 20m of Trenching in OTR inside the customers property?

  • Extra distance over 20m (MM-6b1) per meter

  • Was there more than 2 metres of trenching in OTR required from the property boundary to the Network pit?

  • Extra distance over 2m (MM-6b2) per metre

  • Was there any Non-Trenching Methods used?

  • Was there any Rock

  • How many metres of Trenching in rock (FF-9c1) per m

  • Rock Photos

  • Sequence Number

  • Sequence Number

  • Groundomat Photo

  • Groundomat Distance Photo

  • How many metres of Groundomat in OTR (FF-12f1)

  • Establishment Charge (FF-12g2)

  • Sequence Number

  • Boring Photo

  • Boring Distance Photo

  • How many metres of Boring in OTR (FF-12a2)

  • Establishment Charge (FF-12g1)

  • Was there any Breakout & Reinstatement

  • Breakout Details

  • Breakout photos

  • Breakout Qty per square metre (FF-18a)

  • Breakout photos

  • Breakout Qty per square metre (FF-18b)

  • Breakout photos

  • Breakout Qty per square metre (FF-18c)

  • Reinstatement Types

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c3)

  • Reinstatement Detail

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b3)

  • Did you provide a conduit entry into an Asbestos pit (FF-4c)

  • Asbestos Photos

  • Was a pit required to be installed over existing conduit (FF-2b1)?

  • Sequence Number

  • Was P50 trenching required on site?

  • Sequence Number

  • How many metres of P50 trenching was required on site (FF-9a1)?

  • Was a new pit required to be installed (FF-1b1)?

  • Was There Any Blockages?

  • Type of Blockage

  • How many Buried Pits located (FF-15)?

  • Buried Pit before

  • Buried Pit After

  • How Many High Pressure Flushes (EE-14f)?

  • Spit water flush photo

  • How Many Low Pressure Flushes (EE-14g)?

  • Low pressure flush photo

  • How many Network blockages fixed (EE-14a1)?

  • Blockage Before

  • Blockage Repaired

  • Blockage Area After

  • Was there any E/O

  • E/O Length EE14c1

  • Extra Length per metre (EE-14c1)

  • Additional length photo

  • E/O Depth EE14E1

  • Extra Depth per 500mm (EE-14e1)

  • Additional depth photo

  • Was there any Breakout & Reinstatement

  • Breakout Details

  • Breakout photos

  • Breakout Qty per square metre (FF-18a)

  • Breakout photos

  • Breakout Qty per square metre (FF-18b)

  • Breakout photos

  • Breakout Qty per square metre (FF-18c)

  • Reinstatement Types

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c3)

  • Reinstatement Detail

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b3)

  • Was Lead-in over 40m?

  • Extra distance over 40m (DD-5a7) per metre

  • Was There Any Blockages?

  • Type of Blockage

  • How many Buried Pits located (FF-15)?

  • Buried Pit before

  • Buried Pit After

  • How Many High Pressure Flushes (EE-14f)?

  • Spit water flush photo

  • How Many Low Pressure Flushed (EE-14g)?

  • Low pressure photo

  • How Many (MM-8a1)?

  • Blockage Before Photo

  • Blockage Repair Photo

  • Blockage Area After Photo

  • Was there any Breakout & Reinstatement

  • Breakout Details

  • Breakout photos

  • Breakout Qty per square metre (FF-18a)

  • Breakout photos

  • Breakout Qty per square metre (FF-18b)

  • Breakout photos

  • Breakout Qty per square metre (FF-18c)

  • Reinstatement Types

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c3)

  • Reinstatement Detail

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b3)

  • How Many Y Joiners installed (MM-8a2)?

  • Before Photo

  • Y Joiner Installed

  • Area After Photo

  • Was there additional metres above 2m required as part of a LIC extension (MM-6b1)?

  • How many metres above 2m were required (MM-6b1)?

  • Was there any Breakout & Reinstatement

  • Breakout Details

  • Breakout photos

  • Breakout Qty per square metre (FF-18a)

  • Breakout photos

  • Breakout Qty per square metre (FF-18b)

  • Breakout photos

  • Breakout Qty per square metre (FF-18c)

  • Reinstatement Types

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c3)

  • Reinstatement Detail

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b3)

  • How many Network blockages fixed (EE-14a1)?

  • Blockage Before

  • Blockage Repaired

  • Blockage Area After

  • Was there any E/O

  • E/O Length EE14c1

  • Extra Length per metre (EE-14c1)

  • Additional length photo

  • E/O Depth EE14E1

  • Extra Depth per 500mm (EE-14e1)

  • Additional depth photo

  • Was there any Breakout & Reinstatement

  • Breakout Details

  • Breakout photos

  • Breakout Qty per square metre (FF-18a)

  • Breakout photos

  • Breakout Qty per square metre (FF-18b)

  • Breakout photos

  • Breakout Qty per square metre (FF-18c)

  • Reinstatement Types

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c3)

  • Reinstatement Detail

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b3)

PCD Testing and Final Photos

  • PCD installed

  • After photo open

  • PCD installed in an accessible area

Aerial Lead-In Details

  • Lead-In Length

  • Your Lead-in Length has exceeded 40m please ensure RG11 is installed.

  • Cable Type

  • Lead-In Photo

  • Was Additional Span Required

  • Was there E/O installation of new coaxial drop in-span required (HFC-9a2)?

  • In-span coaxial drop Photo

  • Was there E/O for additional spans of aerial drop HFC-9a3?

  • How Many additional spans were required (HFC-9a3)

  • Additional Span Photos

  • New House Riser Installed?

  • Riser Type Installed?

  • Fascia Riser Photo

  • New Pole Riser Installed? (CC-2c2)

  • Was drop cable installed through existing riser (DD-5a9)

  • Riser Photo

  • Was it over 2m in length FF9a1

  • Additional m over 2m (FF-9a1)

  • Was there any Breakout & Reinstatement

  • Breakout Details

  • Breakout photos

  • Breakout Qty per square metre (FF-18a)

  • Breakout photos

  • Breakout Qty per square metre (FF-18b)

  • Breakout photos

  • Breakout Qty per square metre (FF-18c)

  • Reinstatement Types

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c3)

  • Reinstatement Detail

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b3)

  • Did you provide a conduit entry into an Asbestos pit (FF-4c)

  • Asbestos Photos

  • Bandit Strapping CC2f each band

  • Bandit Strapping Photos

  • How many bandit straps installed (CC-2f)?

  • Was There Any Blockages?

  • Type of Blockage

  • How many Buried Pits located (FF-15)?

  • Buried Pit before

  • Buried Pit After

  • How Many High Pressure Flushes (EE-14f)?

  • Spit water flush photo

  • How Many Low Pressure Flushes (EE-14g)?

  • Low pressure flush photo

  • How many Network blockages fixed (EE-14a1)?

  • Blockage Before

  • Blockage Repaired

  • Blockage Area After

  • Was there any E/O

  • E/O Length EE14c1

  • Extra Length per metre (EE-14c1)

  • Additional length photo

  • E/O Depth EE14E1

  • Extra Depth per 500mm (EE-14e1)

  • Additional depth photo

  • Was there any Breakout & Reinstatement

  • Breakout Details

  • Breakout photos

  • Breakout Qty per square metre (FF-18a)

  • Breakout photos

  • Breakout Qty per square metre (FF-18b)

  • Breakout photos

  • Breakout Qty per square metre (FF-18c)

  • Reinstatement Types

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19a3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19c3)

  • Reinstatement Detail

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19d2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19e2)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19f3)

  • Reinstatement Details

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b1)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b2)

  • Reinstatement photos

  • Reinstatement Qty per square metre (FF-19b3)

PCD Testing and Final Photos

  • PCD installed

  • After photo open

  • PCD installed in an accessible area

QA Check

  • Was a JSEA completed and signed

  • Is the PCD 150mm clear of all structures

  • Is the RF signal within Spec

  • Has the site been left clean and tidy

  • All work has been completed

  • Add 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.