Title Page
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CONDUCTED ON
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ELECTRICAL WORKER NAME
- ANTHONY HOPKINS
- DAN HUTTON
- HARRY PYMONT
- BEAU HARRIS
- ALEC DANELUTTI
- CALLUM COLLINS
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SAFETY OBSERVER NAME
- ANTHONY HOPKINS
- DAN HUTTON
- HARRY PYMONT
- BEAU HARRIS
- ALEC DANELUTTI
- CALLUM COLLINS
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TRAFFIC CONTROLLERS NAMES
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SITE CONDITIONS
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HAVE ALL MEMBERS OF THE WORK GROUP SIGNED ONTO THE RISK ASSESSMENT AND APPLICABLE SWMS FOR THE WORK
POLE INSPECTION
- POLE INSPECTION
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STREET ADDRESS
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CONDUCTED ON
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PHOTO OF ENTIRE POLE
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PHOTO OF POLE NUMBER
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POLE NUMBER
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RECORD LUMINAIRE TYPE/SIZE (LOCATED WITHIN FITTING)
- Cree STR-LWY-2S-__-08-E-UL-525-40K-CONFIGURED – 133W
- Cree STR-LWY-3M-__-04-E-UL-350-40K-CONFIGURED – 44W
- Cree STR-LWY-3M-__-02-E-UL-350-40K-CONFIGURED – 24W
- SYLVANIA L80-25-L3 RoadLED Midi 100W 4K Aeroscreen
- SYLVANIA L40-3M-L3 StreetLED3 24W Aeroscreen
- SYLVANIA L20-3M-L3 StreetLED3 17W 4K Aeroscreen
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RATE 3 LABEL IS VISIBLE
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POLE ID LABEL IS VISIBLE
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CHECK LUMINAIRE TIGHT/LEVEL CONNECTION TO OUTREACH
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CLEAN/WIPE DOWN LUMINARE FITTING
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ARE THERE ANY ABNORMALITIES?
- REPLACED HATCH SCREW
- ANT OR BUG INFESTATION
- INCORRECTLY WIRED
- NO ISOLATOR IN POLE
- NO ISOLATON POINT
- NO FUSE IN CABLE JOINT AT CLOSEST PIT (JU POLES)
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REPLACE PE CELL
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CONFIRM OPERATION OF FITTING
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CONFIRM ALL LED MODULES WORKING
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HOW MANY LED'S ARE NOT WORKING?
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PHOTO OF COMPLETED WORKS
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HAS THE SITE BEEN LEFT NEAT AND TIDY, HAS THE POLE HATCH BEEN SECURED?
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ANY OTHER THINGS TO REPORT?
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PLEASE PROVIDE DETAILS
COMPLETION
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HAVE ALL POLES BEEN CLOSED UP AND HATCH SCREWS SECURED?
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HAVE ALL TRAFFIC CONTROL DEVICES BEEN REMOVED FROM SITE?
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HAS ALL WASTSE BEEN REMOVED FROM SITE?
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HAVE ANY INCIDENTS OR NEAR MISSES OCCURED?
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