Pole inspection Form

• Your name

• Date of inspection

  Date
• Location - stand next to pole when selecting
  Address

General details

• What type of pole structure is this?

  Single

  Double

  H Structure

• What is the pole condition?

  Green

  Amber

  Red

• What is the asset number?

• Is there signage?

  Yes

  No

• Is there a Possum Guard

  Yes

  No
Crossarm Assessment - Create one per level

• What level is this arm

  L1

  L2

  L3

• What is the assembly type?

  Single Pin

  Double Pin

  Strain

• What is the crossarm condition for this arm?

  Green

  Amber

  Red

Stay Assessment

• What is the condition of the stay?

  Green

  Amber

  Red

  N/A

Any additional comments or photos you would like to add?

• Please add them here: