Pole Survey Sheet

• Conducted on

  Date

• Prepared by

• Pole Address

• Grounded

  Yes

  No

• Bonded

  Yes

  No

• Ground line circumference

• Pole Sequence #

• Pole Tag #

• Pole Condition

  Good

  Fair

  Poor

• Pole Class

  Select 1 2 3 4 5 6 7 Unknown

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • Unknown

• Pole Height

  Select 25 30 35 40 45 Unknown

  • 25
  • 30
  • 35
  • 40
  • 45
  • Unknown

• Pole Species

  Select WC WP JP LP NP DF SP WL Unknown

  • WC
  • WP
  • JP
  • LP
  • NP
  • DF
  • SP
  • WL
  • Unknown

• Transformer

  Select 10kv 15kv 25kv 37.5kv 50kv 75kv 100kv 167kv 250kv 333kv 500kv Unknown

  • 10kv
  • 15kv
  • 25kv
  • 37.5kv
  • 50kv
  • 75kv
  • 100kv
  • 167kv
  • 250kv
  • 333kv
  • 500kv
  • Unknown

• Capacitor Bank

  Yes

  No

• Distance to next pole + direction

• Midspan (If Applicable)

ATT Attachment

• Existing HOA

• Strand Size

• # of Cables

CATV Attachment

• Existing HOA

• # of Cables

• Strand Size

Power

• Existing HOA

• # of Cables

Notes

• Tree Trimming

• Footage needed for trimming (est)

• Remove Pole Steps

• Pole Transfer Needed

• Existing Attachments Need To Be Moved

• POLE NOT ACCESSIBLE

• Photos

  Media