Information
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NGA Scoping Form
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Conducted on
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Prepared by:
Customer / Job Details
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Name
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Address
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Contact
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SO Number
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Commit Date
Civil Required
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Detailed description of civil works required
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Add labelled photos using the 'inote HD' app
Health, Safety and Environmental Issues
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Underfloor access?
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Ceiling access?
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Location of ETP?
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Pipe direct into house?
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Digging in communal network required?
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Gas detector required?
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Dogs on site?
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Number of pits / manholes between FAT and premise?
Consents Required
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Right of way?
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Multi dwelling unit?
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Protected trees (Arborist required)?
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Heritage land?
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Heritage buildings?
Network
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Fibre type?
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Network type?
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50mm drop off correctly installed?
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Water in chambers?
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Tapes in place?
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Tapes moving?
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Tapes connected to correct FAT?
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FAT location?
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Cabinet location?
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Length of haul / blow?
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Distance from FAT to boundary?
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Distance from boundary to ETP?
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Length of slack to leave at ETP?
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Length of slack to leave at FAT?
Internal information
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WYAH materials?
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Internal cable route?
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Location of ONT?
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Location of RGW?
Additional notes
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Notes
Ultra-Fast Broadband Installation Consent
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If you are not the person who ordered service (the customer), please confirm that you are authorised to represent the customer.
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We will carry out the work in accordance with Chorus' End User Terms (available at www.chorus.co.nz/ufb-terms).
Outside property consent
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Hole excavation and trenching?
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Removal of concrete/tiling/pavement?
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Installation of conduit(s)?
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Removal of existing copper line to the house?
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Others?
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Clean up: We will leave the property in a clean and tidy state on competition. This does not include reinstatement to the same condition.
Inside property consent
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Drilling small holes?
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Cutting holes in walls?
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Exposed surface wiring?
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Removal of ceiling tiles?
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Surface mounted installation and hardware?
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Others?
Signed consent
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I confirm that:
- I have seen, read and understood this information and the end user terms and accept those terms; and
- If I am not the owner of the property, I have obtained the consent of the owner for the installation works; and
- I understand that there may be an impact on the operation of burglar and medical alarms, particularly monitored alarms. [Note: check with your alarm provider or telecommunications service provider] -
End user signature:
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Authorised Chorus technician: