• S/O Number & Address

  • Address

  • S/O Number

  • Commit date

  • Prepared by: Phone Number:

  • Please email form to: & upload document to Sitetrax

Next Actions

  • Was a half scope or full scope completed?

  • 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

  • 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

  • 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?

  • 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?

  • Type of Pole

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

  • Take photo of servicing OFDC or junction box.

  • 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:

  • Type of network?

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

  • What is required?

  • Traffic Management Required?

  • Where is the TMP is required?

Scoping Details

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

  • Drop off located as per NETMAP?

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

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

  • 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)

  • 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

  • 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

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

OSB Network

  • Water in chambers?

  • Tapes in place?

  • FAT ID and location?

  • Cabinet ID and location?

  • Distance from boundary to ETP?

Additional Consents Required

  • Additional ROW Consent Required?

  • Additional MDU Consent Required?

  • Additional Heritage site or Building Consent Required?

Health, Safety and Environmental Issues

  • Underfloor access?

  • Ceiling access?

  • Location of ETP?

  • Gas detector required?

  • Dogs on site?

Internal information

  • Preferred location of ONT?

  • Preferred location of RGW?

Additional notes

  • Notes

Customer Details and Consent

  • Name and contact number

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

  • If you are not the person who ordered service (the customer), please confirm that you are authorised to represent the customer.

  • We will carry out the work in accordance with Chorus' End User Terms (available at

Outside House/Building consent

  • Hole excavation and trenching?

  • Removal of concrete/tiling/pavement?

  • Installation of conduit(s)?

  • Removal of existing copper line to the house?

  • Others?

  • Clean up: We will leave the property in a clean and tidy state on competition. This does not include reinstatement to the same condition.

Inside House/Building consent

  • Drilling small holes?

  • Cutting holes in walls?

  • Exposed surface wiring?

  • Removal of ceiling tiles?

  • Surface mounted installation and hardware?

  • Others?

Signed consent

  • I confirm that:
    - I have seen, read and understood this information and the end user terms and accept those terms; and
    - If I am not the owner of the property, I have obtained the consent of the owner for the installation works; 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 telecommunications service provider]

  • End user signature:

  • Authorised Chorus technician:

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.