Region 4 - Completion Evidence Report

• Site conducted

  Select

• Engineer Name

• Conducted on

  Date
• Location
  Address

• Customer Number

• Works Completed?

  Yes

  No

Permits

• Is this OH or UG?

  Overhead

  Underground

• Is this Fault or AC?

  FAULT

  AC

  N/A

• Number of spans from MST/CBT

• External Wall Box?

  Yes

  No

• Assist/hoist? Please type Hoist/Assist/None

• Is this Fault or AC?

  FAULT

  AC

  N/A

• Has the permit to dig & POWRA been completed for works?

  Yes

  No

• Is the excavation in public under a permit or in private?

  Public under a permit

  Private works

  No dig

• Has the permit been started and closed?

  Yes

  No

• Surface type (Select all that apply)

  Select C/W F/W Tarmac Concrete Pavers Slabs Soft

  • C/W
  • F/W
  • Tarmac
  • Concrete
  • Pavers
  • Slabs
  • Soft

• Measurements of dig

• External Wall Box

  Yes

  No

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• Light test reading at MST completed (Include pictures)

  Yes

  No

• Light test reading completed on Cable (Include pictures)

  Yes

  No

• Length of cable consumed (Include pictures)

  Select 35m (OH) 50m 65m (OH) 100m 105m (OH) 150m 160m (OH) 200m 250m 300m 350m 400m 450m 500m N/A

  • 35m (OH)
  • 50m
  • 65m (OH)
  • 100m
  • 105m (OH)
  • 150m
  • 160m (OH)
  • 200m
  • 250m
  • 300m
  • 350m
  • 400m
  • 450m
  • 500m
  • N/A

• Length of cable actually needed

• Internal/External Cable Consumed

  Select 5m 10m 20m 30m 50m N/A

  • 5m
  • 10m
  • 20m
  • 30m
  • 50m
  • N/A

• Internal/External Cable actually used

Internal Works

• Length of internal cable consumed

  Select 1.5m 3m 5m 10m 15m 20m 25m 50m N/A

  • 1.5m
  • 3m
  • 5m
  • 10m
  • 15m
  • 20m
  • 25m
  • 50m
  • N/A

• Actual length of internal cable used

• Beacons?

  Yes

  No

• How many beacons?

• Speed Test Results

• Number of devices connected

• Number of speed tests internally

• Duration of works (HH:MM)

• Any additional information?