NGA Last Step fibre Scoping Form

• S/O Number

• Address

• Commit date

  Date

• Prepared by:

Next Actions

• Half scope or full scope completed?

  Full scope

  Half scope

• Why is this job referred to LSF?

  Select No existing duct >15m ISB Haul through existing duct > 200 ISB Aerial spans ISB > 1

  • No existing duct >15m ISB
  • Haul through existing duct > 200 ISB
  • Aerial spans ISB > 1

• How many spans in total?

• What is the total inside boundary length?

• 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?

  No

  Yes

• 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 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

• Traffic Management Required?

  LvL2

  No

  Other

• What is the TMP required?

• Where is the TMP required?

  FAT only

  Outside customers premise only

  At both the FAT and premises

  Other

• Where is the TMP require?

• Other requirements? I.e Arborist

  Select No Obstruction plans required Arborist Other

  • No
  • Obstruction plans required
  • Arborist
  • Other

• What is required?

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

  No

  Written

  Verbal

  Both

• What work type is to be claimed on completion of the LSF build?

  Select 1. Aerial (560) 2. Haul (561) 3. Surface Mount (562) 4. Shallow Trench (563) 5. Drill or slot Trench in Concrete (564) 6. Hard Surface Trenching (565)

  • 1. Aerial (560)
  • 2. Haul (561)
  • 3. Surface Mount (562)
  • 4. Shallow Trench (563)
  • 5. Drill or slot Trench in Concrete (564)
  • 6. Hard Surface Trenching (565)

Customer / Job Details

• Name and contact number

Job instructions

• Agreed location of the ONT?

• Detailed description of works required

• Add labelled photos using the 'inote HD' app

  Media

Health, Safety and Environmental Issues

• Gas detector required?

  Yes

  No

  N/A

Consents Required

• Right of way, MDU or Heritage site?

  Yes

  No

  N/A

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