• S/O Number

  • Address

  • Commit date

  • Prepared by:

Next Actions

  • Was a half scope or full scope completed?

  • Skill set Required?

  • Civil required?

  • What Civil Skill set required?

  • 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

  • Other requirements? I.e TMP, Arborist

  • What is required?

  • Customer consent granted? Written, Verbal or both

Customer / Job Details

  • Name

  • Contact

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?

  • Gas detector required?

  • Dogs on site?

Consents Required

  • Right of way?

  • Multi dwelling unit?

  • Heritage site or Building?


  • 50mm drop off correctly installed?

  • Water in chambers?

  • Tapes in place?

  • Tapes moving?

  • Tapes connected to correct FAT?

  • FAT location?

  • Cabinet location?

  • Distance from FAT (Fixed) or Cabinet (ABF) 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.

  • We will carry out the work in accordance with Chorus' End User Terms (available at

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.