Information

  • NGA Scoping Form

  • Conducted on

  • Prepared by:

Customer / Job Details

  • Name

  • Address

  • Contact

  • SO Number

  • Commit Date

Civil Required

  • Detailed description of civil works required

  • Add labelled photos using the 'inote HD' app

Health, Safety and Environmental Issues

  • Underfloor access?

  • Ceiling access?

  • Location of ETP?

  • Pipe direct into house?

  • Digging in communal network required?

  • Gas detector required?

  • Dogs on site?

  • Number of pits / manholes between FAT and premise?

Consents Required

  • Right of way?

  • Multi dwelling unit?

  • Protected trees (Arborist required)?

  • Heritage land?

  • Heritage buildings?

Network

  • Fibre type?

  • Network type?

  • 50mm drop off correctly installed?

  • Water in chambers?

  • Tapes in place?

  • Tapes moving?

  • Tapes connected to correct FAT?

  • FAT location?

  • Cabinet location?

  • Length of haul / blow?

  • Distance from FAT to boundary?

  • Distance from boundary to ETP?

  • Length of slack to leave at ETP?

  • Length of slack to leave at FAT?

Internal information

  • WYAH materials?

  • Internal cable route?

  • Location of ONT?

  • Location of RGW?

Additional notes

  • Notes

Ultra-Fast Broadband Installation Consent

  • If you are not the person who ordered service (the customer), please confirm that you are authorised to represent the customer.

  • We will carry out the work in accordance with Chorus' End User Terms (available at www.chorus.co.nz/ufb-terms).

Outside property consent

  • Hole excavation and trenching?

  • Removal of concrete/tiling/pavement?

  • Installation of conduit(s)?

  • Removal of existing copper line to the house?

  • Others?

  • 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

  • Drilling small holes?

  • Cutting holes in walls?

  • Exposed surface wiring?

  • Removal of ceiling tiles?

  • Surface mounted installation and hardware?

  • Others?

Signed consent

  • 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:

  • Authorised Chorus technician:

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.