Information
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S/O Number
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Address
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Commit date
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Prepared by:
Next Actions
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What outside installation method is to be completed?
- 1. Aerial
- 2. Haul
- 3. Surface Mount Cable
- 4. Shallow Trench
- 5. Drill or slot Trench in Concrete
- 6. Hard Surface Trenching
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Chorus approval required
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Was a half scope or full scope completed?
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Type of network?
- Air Blown Fiber Blow
- Fixed Fiber Haul
- Aerial (overhead)
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Specific skills required?
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What Skill set required?
- Ruggerdised
- Trenching
- Concrete cutting
- Drill shot required
- Blocked duct under concrete
- Blowing distance greater than 500m
- Outside Boundary remedial
- Other
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Distance of drill shot? Note: If less than 20m a grundomat can be used.
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Distance of trenching?
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Short description of other
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Short description of what is required
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Other requirements? I.e TMP, Arborist
- No
- L2 TMP
- Arborist
- Obstruction plans required
- Other
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What is required?
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Customer consent granted? Only Written consent is accepted
Customer / Job Details
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Name
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Contact
Job instructions
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Detailed description of works required
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Add labelled photos using the 'inote HD' app
Health, Safety and Environmental Issues
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Underfloor access?
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Ceiling access?
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Location of ETP?
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Gas detector required?
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Dogs on site?
Consents Required
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Right of way?
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Multi dwelling unit?
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Heritage site or Building?
Network
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Water in chambers?
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FAT/Flash9/Cabinet location?
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Distance from boundary to ETP?
Internal information
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Location of ONT?
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Location of RGW?
Additional notes
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Notes
Ultra-Fast Broadband Installation Consent
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If you are not the person who ordered service (the customer), please confirm that you are authorised to represent the customer.
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We will carry out the work in accordance with Chorus' End User Terms (available at www.chorus.co.nz/ufb-terms).
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
Outside property consent
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Hole excavation and trenching?
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Removal of concrete/tiling/pavement?
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Installation of pipe(s)?
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Removal of existing copper line to the house?
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Others?
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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 property consent
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Drilling small holes?
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Cutting holes in walls?
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Exposed surface wiring?
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Removal of ceiling tiles?
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Surface mounted installation and hardware?
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Others?
Signed consent
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I confirm that:
- I have seen, read and understood this information and the end user terms and accept those terms; and
- I agree to Chorus undertaking the installation works and method chosen at or on the property; 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
- I agree Chorus may share my information it has gathered or holds about me with phone and broadband providers for the purpose of connecting my property to Chorus' network via fibre. -
End user signature:
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Authorised Chorus technician:
