NGA CV MOBILE SCOPING FORM - Ver 4.0

• S/O Number

• Address

• Commit date

  Date

• Prepared by:

Next Actions

• Was a half scope or full scope completed?

  Full scope

  Half scope

• Is the installation occuring on an?<br>Note: Last step fibre refers to a business ( including schools) with the following criteria<br>a) No existing duct from from boundary to FTP greater than 15m<br>b) Existing duct between boundary and FTP greater than 100m <br>c ) Grater than 1 aerial span boundary to FTP

  SDU

  MDU

  ROW

  Last Step Fibre

  School

• Is the build complete? <br>E.g. In an MDU has a budi been installed in the building or on a ROW is there ducting in place

  Yes

  No

• STOP: Please notify your Manager
  

• STOP: Please notify your Manager

• What work type is to be completed?

  1. Aerial (560)

  2. Haul (561)

  3. Surface Mount (562)

  4. Trenching (563)

• Is this a Chorus Pole?

  No

  Yes

• STOP: Report to Manager

• HIGH COST REQUIRED: Please request for approval for works in - Customer service area = CSA04
  Please send to NGA_Approvals@chorus.co.nz and CVMOBILE@Clearvision.net.nz upon completion of Scope
  
  

• Type of network?

  Select Air Blown Fiber Blow Fixed Fiber Haul Aerial (overhead)

  • Air Blown Fiber Blow
  • Fixed Fiber Haul
  • Aerial (overhead)

• Specific skills required?

  Yes

  No

  N/A

• What Skill set required?

  Select Ruggerdised Trenching Concrete cutting Drill shot required Blocked duct under concrete Blowing distance greater than 500m Outside Boundary remedial Other

  • Ruggerdised
  • Trenching
  • Concrete cutting
  • Drill shot required
  • Blocked duct under concrete
  • Blowing distance greater than 500m
  • Outside Boundary remedial
  • Other

• Distance of trenching?

• Photo of Trench Path

  Media

• Photos of blockage location and if in hard surface. Surface type and panel measurement

• Photo of blockage location

  Media

• Short description of what is required

• Distance of grundomat shot?

• Photo of Grundomat pathway

  Media

• Traffic Management Required at Customer End?

  LV2

  LV 0r LV1

• Please Select which Traffic Management Design (TMD) that needs to be implemented

  F2.1 - If working in footpath and pedestrians can be moved into the Berm

  F2.2 - If working in Footpath and Berm to divert pedestrians into carriageway

  F2.5 - If works are not effecting pedestrians

• STOP: Notify Manager

• Traffic Management Required at FAT/OFDC/CABINET

  LV2

  LV 0r LV1

• Please Select which Traffic Management Design (TMD) that needs to be implemented

  F2.1 - If working in footpath and pedestrians can be moved into the Berm

  F2.2 - If working in Footpath and Berm to divert pedestrians into carriageway

  F2.5 - If works are not effecting pedestrians

• STOP: Notify Manager

• Customer consent granted? Written is mandatory if on site with the customer.

  No

  Written

• Please attach Photo of Consent

  Media

Customer / Job Details

• Name and contact number

Job instructions

• Detailed description of works required

• Add labelled photos using the 'inote HD' app

  Media

Health, Safety and Environmental Issues

• Underfloor access?

  Yes

  No

  N/A

• Ceiling access?

  Yes

  No

  N/A

• Location of ETP?

• Gas detector required?

  Yes

  No

  N/A

• Dogs on site?

  No

  Yes

Network

• Water in chambers?

  Yes

  No

  N/A

• Tapes in place?

  Yes

  No

  N/A

• FAT location?

• Cabinet location?

• Distance from boundary to ETP?

Internal information

• Preferred location of ONT?

• Preferred location of RGW?

Additional notes

• Notes