• S/O Number

  • Address

  • Commit date

  • Prepared by:

Next Actions

  • Half scope or full scope completed?

  • Why is this job referred to LSF?

  • How many spans in total?

  • What is the total inside boundary length?

  • Type of network?

  • Specific skills required?

  • What 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

  • Traffic Management Required?

  • What is the TMP required?

  • Where is the TMP required?

  • Where is the TMP require?

  • Other requirements? I.e Arborist

  • What is required?

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

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

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

Health, Safety and Environmental Issues

  • Gas detector required?

Consents Required

  • Right of way, MDU or Heritage site?

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.