ITS A55

• PIA NOI number

• Full address including postcode

• name of on site person

• Contact number of on site person

• Date A55 complete

  Date

• Local authority

• What is the A55 for?

  Overhead

  Underground

• What is the overhead issue?

  D pole

  Pole top consolidation

• Have you contacted poling help desk?

  Yes

  No

  N/A

• Is there an alternative route?

  Yes

  No

  N/A

• 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

  Media

• 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?

  Yes

  No

• Is this pole on private property?

  Yes

  No

  Unsure

Pole top consolidation

• Have you contacted poling help desk?

  Yes

  No

  N/A

• Is there an alternative route?

  Yes

  No

  N/A

• 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

  Media

• 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?

  Yes

  No

• Is this pole on private property?

  Yes

  No

  Unsure

• Yes

  No

  N/A

• what is the A55 for?

  Enlarge chamber

  Clear blockage in duct section

  New footway box

  Provide duct capacity

  renew/ replace frame and cover

• Brief description on works required and why

• Where is the chamber?

  carriageway

  Footway

  Verge

  Soft

• what is the current chamber type?

• what type of chamber is required

• Surface type

  Select unmade footway tarmac verge HRA Modular concrete

  • unmade
  • footway tarmac
  • verge
  • HRA
  • Modular
  • concrete

• Is this private property?

  Yes

  No

  Unsure

• Is traffic management required?

  Yes

  No

  Unsure

• Number of bores

• Brief description of works required

• Location of chamber 1 (X & Y)

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

  Media

• Number of cables in bore

• Distance to blockage (m)

• Location of chamber 2 (X & Y)

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

  Media

• 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

  Media

• Are there multiple blockages

  Yes

  No

• 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?

  Select unmade footway tarmac verge HRA Modular concrete

  • unmade
  • footway tarmac
  • verge
  • HRA
  • Modular
  • concrete

• Location of works (X & Y)

• Photo of location marked with X with point of reference

  Media

• Number of ducts to enter chamber

• Duct section number

• Distance to Chamber 1

• Distance to chamber 2

• Is traffic management required?

  Yes

  No

  Unsure

• Brief description of work required

• Location of chamber 1 (X & Y)

• Photo of bore that requires additional capacity marked up

  Media

• Are there any cables that may be recovered?

  Yes

  No

  Unsure

• Location of chamber 2 (X & Y )

• Photo of bore that requires additional capacity marked up

  Media

• Are there any cables that may be recovered?

  Yes

  No

  Unsure

• Duct section number

• Brief description of works required

• Location of chamber (X & Y)

• Type of chamber

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

  Media

• duct section number

  Yes

  No

• Additional duct section number (s)

• OR portal screen shot/ other image of location

  Media

• Location (Grid ref X and Y)

• Signature

  Sign