RATE 3 STREET LIGHTING INSPECTION REV5

• CONDUCTED ON

  Date

• ELECTRICAL WORKER NAME

  Select ANTHONY HOPKINS DAN HUTTON HARRY PYMONT BEAU HARRIS ALEC DANELUTTI CALLUM COLLINS

  • ANTHONY HOPKINS
  • DAN HUTTON
  • HARRY PYMONT
  • BEAU HARRIS
  • ALEC DANELUTTI
  • CALLUM COLLINS

• SAFETY OBSERVER NAME

  Select ANTHONY HOPKINS DAN HUTTON HARRY PYMONT BEAU HARRIS ALEC DANELUTTI CALLUM COLLINS

  • ANTHONY HOPKINS
  • DAN HUTTON
  • HARRY PYMONT
  • BEAU HARRIS
  • ALEC DANELUTTI
  • CALLUM COLLINS

• TRAFFIC CONTROLLERS NAMES

• SITE CONDITIONS

  FINE

  PATCHY RAIN

  HOT

  RAIN

• HAVE ALL MEMBERS OF THE WORK GROUP SIGNED ONTO THE RISK ASSESSMENT AND APPLICABLE SWMS FOR THE WORK

  Yes

  No

  N/A

POLE INSPECTION
• STREET ADDRESS
  Address

• CONDUCTED ON

  Date

• POLE NUMBER

• CAN POLE BE SAFELY ACCESSED?

  Yes

  No

  N/A

• WHY CAN THE POLE NOT BE ACCESSED?

  Select CAR/ VEHICLE PARKED IN WAY LOCATED IN PARK CONSTRUCTION SITE

  • CAR/ VEHICLE PARKED IN WAY
  • LOCATED IN PARK
  • CONSTRUCTION SITE

• PHOTO OF ENTIRE POLE

  Media

• PHOTO OF POLE NUMBER

  Media

• RECORD LUMINAIRE TYPE/SIZE

  Select 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

  • 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

• IS THE RATE 3 LABEL AND POLE ID LABEL VISIBLE?

  Yes

  No

  N/A

• WHICH LABEL NEES TO BE REPLACED?

  Select GREEN 3 POLE ID BOTH

  • GREEN 3
  • POLE ID
  • BOTH

• CHECK LUMINAIRE TIGHT/LEVEL CONNECTION TO OUTREACH

  Yes

  No

  N/A

• HAS THE ISSUE BEEN RECTIFIED

  Yes

  No

  N/A

• WHAT IS THE ISSUE

• CLEAN/WIPE DOWN LUMINARE FITTING

  Yes

  No

  N/A

• REPLACE PE CELL

  Yes

  No

  N/A

• CONFIRM OPERATION OF FITTING

  Yes

  No

  N/A

• CONFIRM ALL LED MODULES WORKING

  Yes

  No

  N/A

• HOW MANY LED'S ARE NOT WORKING?

• PHOTO OF COMPLETED WORKS

  Media

• ARE THERE ANY ABNORMALITIES?

  Select 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)

  • 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)

• HAS THE SITE BEEN LEFT NEAT AND TIDY, HAS THE POLE HATCH BEEN SECURED, HAVE SWITCHBOARDS BEEN CLOSED?

  Yes

  No

  N/A

• ANY OTHER THINGS TO REPORT?

  Yes

  No

  N/A

• PLEASE PROVIDE DETAILS

COMPLETION

• HAVE ALL POLES BEEN CLOSED UP, HATCH SCREWS SECURED AND SWITCHBOARDS BEEN CLOSED AND LOCKED?

  Yes

  No

  N/A

• ARE ALL LIGHTS /CIRCUITS BACK ON?

  Yes

  No

  N/A

• HAS ANYTHING BEEN TAGGED OUT / MADE SAFE THAT REQUIRES FURTHER ATTENTION?

  Yes

  No

  N/A

• HAVE ALL TRAFFIC CONTROL DEVICES BEEN REMOVED FROM SITE?

  Yes

  No

  N/A

• HAS ALL WASTSE BEEN REMOVED FROM SITE?

  Yes

  No

  N/A

• HAVE ANY INCIDENTS OR NEAR MISSES OCCURED?

  Yes

  No

  N/A

• Add signature

  Sign