UCG NGA/MDU Scoping Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Customer Information / Job Details

• Name

• Address

• Contact

• S/O Number

• Commit Date

Health, Safety and Environmental

• Ceiling access?

  Yes

  No

  N/A

• Hatches Required?

  Yes

  No

  N/A

• Drilling Required?

  Yes

  No

  N/A

• Services Located?

  Safe

  At Risk

  N/A

• Fire Stopping Required?

  Yes

  No

  N/A

• Underfloor Access?

  Yes

  No

  N/A

• ETP located?

  Yes

  No

  N/A

• Pipe direct into house?

  Yes

  No

  N/A

• Dogs on site?

  Yes

  No

  N/A

• Digging in road reserve required?

  Yes

  No

  N/A

Consents Required

• Landlord Consent?

  Yes

  No

  N/A

• Right of Way?

  Yes

  No

  N/A

• Protected Trees (Arborist Required on site)?

  Yes

  No

  N/A

• Heritage Building?

  Yes

  No

  N/A

• Heritage Land?

  Yes

  No

  N/A

Network

• Fibre Type?

  Select Air Blown Fixed

  • Air Blown
  • Fixed

• Network type?

  Select Overhead Underground

  • Overhead
  • Underground

• 50mm Drop Off Installed Correctly?

  Yes

  No

  N/A

• Water in pits/manholes?

  Yes

  No

  N/A

• FAT Location?

• FAT ID

• Length of haul / blow?

• Distance from FAT to boundary drop?

• Distance from boundary drop to ETP?

  Yes

  No

  N/A

Civil Required

• Hand dig?

  Yes

  No

  N/A

• Drill?

  Yes

  No

  N/A

• Grundomat?

  Yes

  No

  N/A

• Hydro excavation?

  Yes

  No

  N/A

• Hauling tapes in place?

  Yes

  No

  N/A

• Do the tapes move?

  Yes

  No

  N/A

• Do the tapes go to the correct FAT?

  Yes

  No

  N/A

Reinstatement Required

• Concrete?

  Yes

  No

  N/A

• Grass / Soft surface?

  Yes

  No

  N/A

• Tar seal?

  Yes

  No

  N/A

Additional Information or notes

• Notes