NGA Fibre Ready Scoping Form Version 2.1.1

• S/O Number

• Address

• Commit date

  Date

• Prepared by:

Next Actions

• Skill set Required?

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

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

• Civil required?

  No

  Yes

• What Civil Skill set required?

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

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

• Distance of drill shot? Note: If less than 20m a grundomat can be used.

• Distance of trenching?

• Short description of other

• Short description of what is required

• Customer consent granted?

  Yes

  No

• Total distance from FAT to ETP or Cabinet to ETP

• Any other requirements? I.e TMP, Arborist

  Select No L2 TMP Arborist Obstruction plans required Other

  • No
  • L2 TMP
  • Arborist
  • Obstruction plans required
  • Other

• What is required?

Customer / Job Details

• Name

• Contact

Civil Required

• Detailed description of civil 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?

  Yes

  No

  N/A

Consents Required

• Right of way?

  Yes

  No

  N/A

• Multi dwelling unit?

  Yes

  No

  N/A

• Heritage site or Building?

  Yes

  No

  N/A

Network

• 50mm drop off correctly installed?

  Yes

  No

  N/A

• Water in chambers?

  Yes

  No

  N/A

• Tapes in place?

  Yes

  No

  N/A

• Tapes moving?

  Yes

  No

  N/A

• Tapes connected to correct FAT?

  Yes

  No

  N/A

• FAT location?

• Cabinet location?

• Distance from FAT to boundary?

• Distance from boundary to ETP?

Internal information

• WYAH materials?

• Preferred location of ONT?

• Preferred 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.

  Sign

• 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?

  Yes

  No

  N/A

• Removal of concrete/tiling/pavement?

  Yes

  No

  N/A

• Installation of conduit(s)?

  Yes

  No

  N/A

• Removal of existing copper line to the house?

  Yes

  No

  N/A

• Others?

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

• Cutting holes in walls?

  Yes

  No

  N/A

• Exposed surface wiring?

  Yes

  No

  N/A

• Removal of ceiling tiles?

  Yes

  No

  N/A

• Surface mounted installation and hardware?

  Yes

  No

  N/A

• Others?

  Yes

  No

  N/A

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:

  Sign

• Authorised Chorus technician:

  Sign