NGA Scoping form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Customer / Job Details

• Name

• Address

• Contact

• SO Number

• Commit Date

Health, Safety and Environmental Issues

• Underfloor access?

  Yes

  No

  N/A

• Ceiling access?

  Yes

  No

  N/A

• ETP present?

  Yes

  No

  N/A

• Pipe direct into house?

  Yes

  No

  N/A

• Digging in road reserve required?

  Yes

  No

  N/A

• Gas detector required?

  Yes

  No

  N/A

• Car parked over manhole?

  Yes

  No

  N/A

• Dogs on site?

  Yes

  No

  N/A

• Obstructions to network / premise

  Yes

  No

  N/A

• Number of pits / manholes between FAT and premise?

Consents Required

• Right of way?

  Yes

  No

  N/A

• Multi dwelling unit?

  Yes

  No

  N/A

• Protected trees (Arborist required)?

  Yes

  No

  N/A

• Heritage land?

  Yes

  No

  N/A

• Heritage buildings?

  Yes

  No

  N/A

Network

• Fibre type?

  Air blown

  Fixed

• Network type?

  Overhead (aerial)

  Underground

• 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?

• Length of haul / blow?

• Distance from FAT to ETP?

Civil Required

• Hand dig?

  Yes

  No

  N/A

• Drill?

  Yes

  No

  N/A

• Water?

  Yes

  No

  N/A

• Grundomat?

  Yes

  No

  N/A

Reinstatement Required

• Grass?

  Yes

  No

  N/A

• Seal?

  Yes

  No

  N/A

• Concrete?

  Yes

  No

  N/A

Additional notes

• Notes