UCG Connect Scoping Form V3

• S/O Number

• Address

• Service Order Type

• Commit date

  Date

• Prepared by: Phone Number:

• Please email form to: connect@ucg.co.nz & upload document to Sitetrax

Disclaimer

• The assessors believe the information contained within this risk assessment report to be correct at the time of printing. The assessors do not accept responsibility for any consequences arising from the use of the information herein. The report is based on matters which were observed or came to the attention of the assessors during the day of the assessment and should not be relied upon as an exhaustive record of all possible risks or hazards that may exist or potential improvements that can be made. Information on the latest workers compensation and OHS / WHS laws can be found at the relevant State WorkCover / WorkSafe Authority.

Confidentiality Statement

Terms and Conditions

• Chorus’ End User Terms
  These terms relate to the installation, use and ownership of the line, and any associated equipment and infrastructure, connecting your property to Chorus’ wider network.
  More information about how we install fibre is available on our website, https://www.chorus.co.nz/installing-fibre/fibre-in-your-home-or-business/ufb-installation-easy-as-abc.
  Term Definition approvals All approvals needed for us to lawfully install, locate, access and operate our network in the manner allowed by these terms. Chorus, we, us Chorus New Zealand Limited. Chorus Party This includes: our network; controlled by Chorus or those other network operators; parties listed above; and for. install All works and activities which are necessary to connect your property to our network. network termination point The point at your property where you will connect to our network, this includes the Optical Network Terminal (ONT) and any other Network Interface Device (NID) or the secure jack or other access point where our network ends on your property. property The property you own, occupy or have control over where assets installed and owned by us (or our predecessors, including Telecom New Zealand Limited) are (or are to be) located and will include: or business connections, your business property and the land and buildings located on that property. services All goods and services of any kind we provide to you or your phone and broadband provider and includes operation, repair and maintenance of our network. phone and broadband provider Any other person approved by us who provides you with phone and broadband services that use our network. unit title development A building development governed by the Unit Titles Act 2010 You The consumer or end user of the services

• 1. Agreement
  These terms bind you and us, and apply to your property. You agree that we may install, locate, access and operate our network on your property under these terms. We may enforce these terms directly against you without any involvement from your phone and broadband provider. The things you agree to do under these terms only apply to the extent you are lawfully able to do them and we do not require you to do things you have no actual power do to. Your agreement to be bound by, and comply with, these terms is in exchange for us agreeing to install and/or make our network available for use at your property.
  2. Our network
  Our network includes the connecting line to your property and all associated equipment and infrastructure (including the network termination point), all of which is provided and owned by us and may be located in, on, over or outside of your property. Our network does not include any line or equipment provided by someone else, even if we may use that line or equipment. These terms do not give you any rights in any part of our network; nor will you acquire such rights from your phone and broadband provider.
  3. Terms apply while our network is on your property
  These terms apply between you and us for as long as, and whenever, any of our network is located on or at your property. These terms (and our rights under them) are entirely independent of your relationship with any phone and broadband provider.
  For clarity, none of the rights and benefits conferred on us under these terms will come to an end or be altered as a result of your agreement with a phone and broadband provider ending.

• 4. What you agree to do
  You must: actors come on or into your property to install or work on our network or anything connected to it; we will always try to give reasonable advance notice to the occupier before we do it and the people we send will carry and present proof of their identity. If the access we require to your property is not granted this may impact on the services you or others receive from your phone and broadband provider; and we authorise may work on our network. If you interfere with our network, we have no responsibility of any kind to you for any failure or disruption in the services you obtain from a phone and broadband provider; and person other than a phone and broadband provider to convey or receive, any signal, communication or other service over or using any part of our network unless we first agree (and we may agree subject to conditions).
  You acknowledge that: there are a number of ways by which we may connect our network termination point at your property to our network, including by way of buried cable, aerial cable or surface mounted cable; we will recommend those methods which are most appropriate for connecting your property. In some situations we may require a contribution from you towards Chorus’ costs to connect your property to the Chorus network. If a contribution is required, Chorus will not begin any installation works at or on the property until we have agreed the amount of any such contribution and that agreed contribution has been paid to us; are responsible for ensuring that electricity is supplied safely to where our network termination point will be located; and that is not compliant with any relevant international connection standards, it may adversely affect services you, and possibly others, receive from your phone and broadband provider and/or damage our network; and property at any time after it has been installed by us, Chorus may charge you a fee directly, or via your phone and broadband provider, for the work required to complete this relocation. In addition, Chorus will not be responsible for undertaking, or paying for, any works required to reinstate that area of the property in or on which the network termination point was previously located.
  You agree to pay for repairing or replacing any part of our network which is lost, stolen, or damaged by you or anyone you are responsible for or have control over. If your property is in a multi-unit complex your liability to us will not exceed $500,000 for any event or for any series of related events. Otherwise your liability to us will not exceed $100,000 for any event or for any series of events. You also agree to use your reasonable endeavours to ensure that our rights to our network are not disrupted by anyone else.
  5. Approvals
  If you do not own your property you must ensure that the owner of the property approves the installation, location, access, operation and ownership of our network by us at the property, and in any common areas where the property is part of a multi-dwelling unit (such as an apartment or office building) and the owner of the property also owns all of the units within the development.
  If your property is a unit title development, each unit owner has rights for the passage or provision of telecommunications services through the common property. You agree that you will notify the owner and the body corporate (if applicable) of the installation, location and means of connection of our network and, if Chorus asks you to, you will help us to obtain access to the common property in order to install our network. You will be responsible to us for any loss we suffer if you do not ensure the owner has given their approval. You agree that, if asked, you will provide us with written evidence of this approval.
  If your property is located on a right of way, your acceptance of the Ultra-Fast Broadband Installation Agreement indicates your approval of any work we need to do in the right of way to install a fibre connection to any of your neighbours located on the right of way.
  We may need to install our equipment on or in adjacent land or buildings that you do not own in order to connect the property to our network (for example, an access right of way or the risers that provide access for utilities in a commercial building). You agree that, if asked, you will help us to obtain all the approvals that we need to install that other equipment.
  Unless we have all the approvals we need, we have no responsibility to you for any failure or disruption in the services you obtain from a phone and broadband provider.

• 6. Property damage and liability
  On completion of install and if we damage the property at any time, Chorus will (at Chorus’ cost) repair any damage to any part of the property, including any part affected by the install of the lead-in, as reasonably close as possible to the original condition prior to such damage. Such repair will only be on a “like for like” basis up to a maximum of $500,000 for any event or for any series of related events with a total of $10,000,000 in any 12 month period.
  We would like you to tell us as soon as possible after you become aware that your property is damaged. You agree not to pursue any of our contractors or agents for any such repair costs or damage.
  Other than our liability for property damage as set out above, no Chorus Party is liable to you or has to pay you for anything else caused by or resulting from anything any of them does or does not do, or delays in doing, whether or not it is contemplated or authorised by any agreement you have with us or a phone and broadband provider. This exclusion applies whatever you are claiming for and however liability arises. If for some reason, we cannot rely on this exclusion of liability, the maximum combined amount that the Chorus parties (together) will have to pay you and anyone else who uses the services provided to you (together) are the same amounts set out above for circumstances where Chorus has damaged your property.
  The limitations under this clause 3 do not limit any rights you may have under the Consumer Guarantees Act 1993 or the Fair Trading Act 1986. If you are a business customer who has a written agreement with your phone and broadband provider, the provisions of the Consumer Guarantees Act 1993 may not apply to any services we provide.
  7. Information about you
  You agree that phone and broadband providers may share information they have gathered or hold about you with us and that we may use it and any other information we gather and hold about you (including your name and address) for the purposes of connecting your property to our network and providing services to you and your phone and broadband provider. We may also use any of that information for the purpose of obtaining, maintaining or confirming the existence of any approvals we need.
  We will only share information we hold about you with your phone and broadband provider and the agents and contractors we engage to do work on our network on your property. We may also share information we hold about you with other persons from whom we need approvals. You may ask to see information we hold about you and ask for any details that are wrong to be corrected.
  8. Transferring these terms or our rights
  We may transfer to someone else our rights and benefits under these terms, and our network. You agree that such a transfer can occur without the need for any approval from, or notice to, you. After a transfer, these terms (and all your obligations under these terms) will benefit the person we transfer to. We may also hold our rights and benefits under these terms in whole or in part for the benefit of other persons who may have an interest in our network.
  9. Each term separately binding
  If for any reason any of these terms cannot be enforced or relied on by you or us, all other terms of this agreement remain binding

Next Actions

• Was a half scope or full scope completed?

  Full scope

  Half scope

• Customer was not available at time of survey

• Type of installation ?<br>Note: Last step fibre refers to a business ( including schools) with the following criteria<br>a) No existing duct from from boundary to FTP greater than 15m<br>b) Existing duct between boundary and FTP greater than 100m <br>c ) Grater than 1 aerial span boundary to FTP

  SDU

  MDU

  ROW

  Last Step Fibre

  School

• Is the build complete? <br>E.g. In an MDU has a budi been installed in the building or on a ROW is there ducting in place

  Yes

  No

• STOP: Please contact your Field Manager to discuss next steps

• Please download iAuditor: UCG Connect - Last Step Fibre Inspection Form.V1 & complete all details

• What work type is to be completed?

  Select 1. Aerial (N-560) 2. Haul (N-561) 3. Ruggerdised/Surface Mount (N-562) 4. Trenching (N-563) 5. Drilling (N-564) 6. Hard Surface Reinstatement (N-565) 7. MDU - End Customer Site Cabling (N-552) 8. MDU - Site cabling & Drop req. (N-554)

  • 1. Aerial (N-560)
  • 2. Haul (N-561)
  • 3. Ruggerdised/Surface Mount (N-562)
  • 4. Trenching (N-563)
  • 5. Drilling (N-564)
  • 6. Hard Surface Reinstatement (N-565)
  • 7. MDU - End Customer Site Cabling (N-552)
  • 8. MDU - Site cabling & Drop req. (N-554)

• Aerial Linear distance greater than Ruggerdised or Haul distances, and may include
  - up to 3 sqm Hard Surface reinstatement
  - up to 5m Drilling
  - up to 5m Trenching

• Is the POLE safe to climb?

  No

  Yes

• Type of Pole

  Veerendal Type 1 Pole

  Spun Pole

  Wooden Pole

  Pole with power breaker/transformer

  Other

• Explanatory notes identifying the condition of the pole and reasons for the pole to be unsafe.

• Take photo of servicing OFDC or junction box.

  Media

• Capture pole ID and where aerial feed is connected to.

• Aerial Linear distance greater than Ruggerdised or Aerial distances, and may include
  - up to 3 sqm Hard Surface reinstatement
  - up to 5m Drilling
  - up to 5m Trenching

• Aerial Linear distance greater than Haul or Aerial distances, and may include
  - up to 3 sqm Hard Surface reinstatement
  - up to 5m Drilling
  - up to 5m Trenching

• Trenching more than 5m

• Drilling more than 5m

• Hard Surface Reinstatement greater than 3 sqm

• Chorus approval required

• No further info required

• Please attach photo's showing the Budi before pathway run or fibre blown in tube & after photo's showing pathway completed

• With all N-554 code claims a copy of iAuditor must be emailed to: billing@ucg.co.nz

  Media

• Type of network?

  Air Blown Fiber Blow

  Fixed Fiber Haul

  Aerial (overhead)

• Other requirements? I.e Arborist, Obstuction Plans, etc

  No

  Obstruction plans required

  Arborist

  Other

• What is required?

• Traffic Management Required?

  LV1 TMP

  LV2 TMP

• Where is the TMP is required?

  FAT only

  Outside customers premise only

  At both the FAT and premises

  Other

Scoping Details

• NETMAP view available in job pack identifying the drop off location?

  No

  Yes

• Drop off located as per NETMAP?

  No

  Yes

• Take photo(s) of drop off clearly showing number of tubes & location relative to customer property

  Media

• Takes photos as required for possible drop off options, provide frontage & reinstatement measurements to consider new drop off lateral.

  Media

• Step by step description of build. Format x-y, activity, distance, infrastructure; e.g. 1-2, T in grass 5m, 3xR Key: H -haul; SM – Surface mount; MT - microtrench; T - trench; LL - lift & lay; R - ruggedized; D - duct; FF - Fixed Fibre; G – Grass; GD – Garden; GR - Gravel; S – Seal; C - concrete

• Extensive outside boundary work required? (e.g creation of new drop off, extending existing drop off, extending pole to boundary network)

  No

  Yes

• Explain Why? (e.g Extending the drop off from current location to communal driveway as no duct are available from current drop off to houses. Trenching for 10m in grass is required.

• Please load photos

  Media

• Please ensure that either Scoper or Management have acquired the correct UFB Asbuild (Including Measurements) and UFB CPA if we need to create new lateral.
  Check and confirm.

• Add Aerial view for planned work

  Media

• Add photos for design. Blue - existing; Red - build; Purple - future or for provisioning.

  Media

OSB Network

• Water in chambers?

  Yes

  No

  N/A

• Tapes in place?

  Yes

  No

  N/A

• FAT ID and location?

• Cabinet ID and location?

• Distance from boundary to ETP?

Additional Consents Required

• Additional ROW Consent Required?

  Yes

  No

  N/A

• Additional MDU Consent Required?

  Yes

  No

  N/A

• Additional Heritage site or Building Consent Required?

  Yes

  No

  N/A

Health, Safety and Environmental Issues

• Underfloor access?

  Yes

  No

  N/A

• Ceiling access?

  Yes

  No

  N/A

• Location of ETP?

• Gas detector required?

  Yes

  No

  N/A

• Dogs on site?

  Yes

  No

Internal information

• Preferred location of ONT?

• Preferred location of RGW?

Additional notes

• Notes

Customer Details and Consent

• Reference Number:

• Your (Customer) Name

• Address for the property where installation work will happen:

• If you are not the person or business who ordered the service, please confirm that you are authorised to represent the person or business who ordered the service by noting your name and signing below:

  Sign

• Customer consent granted? Written is mandatory if on site with the customer.

  No

  Written

  Verbal

  Both

• We will carry out the work in accordance with Chorus' End User Terms (available at www.chorus.co.nz/ufb-terms).

• Below is an assessment of the work we’re carrying out to install fibre network equipment to your property. You need to sign below to confirm you agree to these activities. We may also do other works and activities reasonably associated with this kind of work.

Outside your property (Chorus technician to complete):

• Hole excavation and trenching?

  Yes

  No

  N/A

• Removal of concrete/tiling/pavement?

  Yes

  No

  N/A

• Installation of pipe(s)?

  Yes

  No

  N/A

• Removal of existing copper line to the house?

  Yes

  No

  N/A

• Clean up: we will leave the property in a clean and tidy state on completion. We will reinstate on a like for like basis (it may not be possible to match colour, texture or pattern)

• Others?

  Yes

  No

  N/A

Inside your property (Chorus technician to complete):

• Drilling small holes

  Yes

  No

  N/A

• Cutting holes in walls

  Yes

  No

  N/A

• Exposed surface wiring?

  Yes

  No

  N/A

• Removal of ceiling tile

  Yes

  No

  N/A

• Surface mounted installation of hardware

  Yes

  No

  N/A

• Clean up: we will leave the property in a clean and tidy state on completion. We will reinstate on a like for like basis (it may not be possible to match colour, texture or pattern)

• Others?

  Yes

  No

  N/A

• Below is confirmation that the approval of the owner of the property has been obtained:

• Is the signatory the owner of the propery

  No

  Yes

• If no, has the signatory obtained the approval of the owner of the property to the installation works at or on the property and within any common areas?

  No

  Yes

Means of connection to be used (Chorus technician to complete):

• Aerial Cable

  Yes

  No

  N/A

• Surface mounted cable

  Yes

  No

  N/A

• Buried cable - shallow trench

  Yes

  No

  N/A

• Buried cable - existing duct

  Yes

  No

  N/A

• Buried cable - deep trench

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Signed consent

• I have seen, ready and understood the Chorus’ End User Terms and the information in this UFB Installation Agreement and accept both; and

• I agree to Chorus undertaking the installation works and method chosen at or on the property;

• I acknowledge the means of connection to be used to connect my property to the Chorus network; If the work required to connect the property to the Chorus network exceeds contract distance limits, I acknowledge that the Customer is responsible for any agreed costs associated with Chorus’ use of this option to connect the property; and

• I understand that there may be an impact on the operation of burglar and medical alarms, particularly monitored alarms. [Note: check with your alarm provider or phone and broadband provider]

• Your (Customer) signature: Name: Signature:

  Sign

• Select date

  Date

• Authorised Chorus technician: Name: Signature:

  Sign

• Select date

  Date