Title Page

JOB INFORMATION

  • Client

  • Job #

  • Date and Time

  • Field Engineer

  • Address
  • Grounded

  • Bonded

POLE INFORMATION

  • Photo #s

  • Ground Line Circumference

  • Pole Sequence #

  • Pole Tag #

  • Pole Condition

  • Pole Address
  • Pole Class

  • Pole Height

  • Pole Species

  • Transformer Size

  • Capacitor Bank

  • POLE SKETCH (pole, spans & length, achors) (number corresponding to table below)

  • PROFILE POLE SKETCH

ATTACHMENT INFORMATION

  • Telco, CATV, other fiber, streetlight, secondary power

  • Attachment
  • Attachment Type

  • Existing HOA

  • Proposed HOA

  • # of Cables

  • Strand Size

  • Arm Position

ACHORD AND DOWN GUY INFORMATION

    Anchor
  • Photo

  • Surface

  • Eyes

  • Size

  • Lead

Down Guy Size (2m, 6m,10,16m,25m)

  • Power

  • Telco

  • CATV

  • COMM

  • Queens Height

NOTES

  • Remove Pole Steps

  • Tree Triimming

  • Approx (ft.)

  • Between P

  • and P

  • Pole Removal Needed

  • Pole Transfer Needed

  • Existing Attachments need to be removed

  • Poel not accessible

  • Notes

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.