Information
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S/O Number
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Address
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Commit date
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Prepared by:
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FULL SCOPE MUST BE COMPLETED. CONTRACTOR CAN CLAIM A 701 CODE UPON COMPLETION OF A LAST STEP FIBRE SCOPE. LAST STEP FIBRE CAN ONLY BE FOR A SINGLE DWELLING PREMISE BASED ON THE 8 DIFFERENT CRITERIA'S BELOW. PLEASE ENSURE YOU ADVISE EACH DIFFERENT SURFACE METHOD USED ISB.
Next Actions
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Type of network?
- Yes
- No
- N/A
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Why is this job referred to LSF?
- RESIDENTIAL - existing conduit or open trench greater than 200m
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What is the total inside boundary distance (boundary to FTP location) of the existing open trench that will be utilised?
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What is the surface type of the open trench that will require reinstating?
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What is the total distance of the new thrust/drill required (boundary to FTP location)?
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What is the surface type you will be pot holing in for drill set up and locating services for reinstating?
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What is the total distance of the new trench required (boundary to FTP location)?
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What is the surface type you will be trenching through and reinstating?
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What is the total distance of the surface mount required (please note this does not include surface mount inside the premise only boundary to FTP location) ?
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What is the total new lead in distance (boundary to FTP location)?
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What is the surface type you will be trenching through and reinstating?
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What is that total inside boundary distance of existing conduit/trench (boundary to FTP)?
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What is the surface type of the open trench that will require reinstating?
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What is the total number of aerial spans FTP back to boundary pole?
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Is an EWP required?
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What is the total distance inside boundary of existing duct to be hauled through (boundary line to FTP location)?
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Specific skills required?
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Traffic Management Required?
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What is the TMP required for?
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Where is the TMP required?
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Is there any special outside boundary considerations to be made to connect the lead in service to (i.e. drop off not usable, new drop off to be created)?
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Other requirements? I.e Arborist / Heritage building consent / EWP / weekend work
- YES
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What is required?
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Customer must sign off on agreed scope while on site.
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What work type is to be claimed on completion of the LSF build?
Customer / Job Details
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Name and contact number
Job instructions
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Agreed location of the ONT?
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Detailed description of works required
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Add labelled photos using the 'inote HD' app
Health, Safety and Environmental Issues
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Gas detector required?
Consents Required
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Right of way, MDU or Heritage site?
Additional notes
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Notes
Ultra-Fast Broadband Installation Consent
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If you are not the person who ordered service (the customer), please confirm that you are authorised to represent the customer.
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We will carry out the work in accordance with Chorus' End User Terms (available at www.chorus.co.nz/ufb-terms).
Outside property consent
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Hole excavation and trenching?
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Removal of concrete/tiling/pavement?
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Installation of conduit(s)?
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Removal of existing copper line to the house?
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Others?
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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
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Drilling small holes?
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Cutting holes in walls?
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Exposed surface wiring?
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Removal of ceiling tiles?
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Surface mounted installation and hardware?
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Others?
Signed consent
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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:
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Authorised Chorus technician:
