Title Page

  • Date and Time

  • Engineer

  • CMID

  • Location
  • Copper/Fibre

  • Customer Name and Contact Number

Site Information

  • Invisilight?

  • Pre-installed socket/media converter?

  • External cabling?

  • Internal cabling?


  • Have you contatced your FTM for assistance prior to submitting this form?


  • Is stage 1 cable damaged?

  • Is stage 1 cable missing?

  • Long Ladders Required?

  • UG Training Required?

  • Additional Information


  • Have you completed a power/Navitek test?

  • Photo of power level/Navitek result from DP

  • Photo of power level/Navitek result from customer


  • Have you rekroned socket/respliced media coverter?

  • Have you rekroned IDC/respliced CSP?

  • Have you checked local hatches/risers for breaks?

  • Have you performed a thorough inspection of your internal installation checking for breaks etc?

Additional Photos

  • Photo of cab

Cab Location

  • undefined

  • Photo of front of house/flat (showing full house if long ladders needed)

Additional Information

  • Is BM approval required to complete repair works?

  • Any other access information required? e.g. risers locked with site specific keys

Customer Availability

  • Preferred date for re-visit in the next 7 days

  • AM or PM slot required?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.