Signals Pole / Pit Damage

• Notification No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Damaged Asset Information

• Pit Size

  Select 1 Pit 2 Pit 3 Pit 4 Pit 5 Pit 6 Pit 7 Pit 8 Pit

  • 1 Pit
  • 2 Pit
  • 3 Pit
  • 4 Pit
  • 5 Pit
  • 6 Pit
  • 7 Pit
  • 8 Pit

• Post Type

  Select 4.1m Pole Joint use Pole Mast Arm Pole Joint use / Mast Arm Pole Stub Pole

  • 4.1m Pole
  • Joint use Pole
  • Mast Arm Pole
  • Joint use / Mast Arm Pole
  • Stub Pole

• Initial Identification

  Safe

  At Risk

  N/A

• Where is the damaged asset located?

• Has the area being left safe?

  Yes

  No

  N/A

• Attach photo of how site is left.

  Media

• Provide any additional information.

Technician

• Add signature

  Sign